What Are the Secrets to Aging Well? Dr. Sherwin Nuland, author and professor of surgery at Yale Medical School, explains how the quality of our last decades remains within our control and that aging, in and of itself, is an art.
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What Are the Secrets to Aging Well?

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What Are the Secrets to Aging Well?

What Are the Secrets to Aging Well?

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This is TALK OF THE NATION. I'm Neal Conan in Washington.

As we get older, all of us notice unmistakable signs of aging; that creak in your knee maybe, or the onset of diabetes. We live in a terror of Alzheimer's or Parkinson's, cancer or stroke, and we fear the prospect of the nursing home. In a new book, Dr. Sherwin Nuland, himself a septuagenarian, argues that while death is inevitable, for many people the quality of our last decades remains within our control, that aging is not a disease in and of itself but an art. The book is aimed at folks in their fifties and sixties, so we ask you boomers: Is aging a sentence or an opportunity? Join the conversation. Our number here in Washington is 800-989-8255, 800-989-TALK. Our e-mail address is talk@npr.org. You can also join the conversation at our blog, npr.org/blogofthenation.

Later this hour, new-age gossip comes to the nation's capital. But first, Sherwin Nuland joins us from our bureau in Chicago. He's professor of surgery at Yale University Medical School and the author of "How We Die" and, most recently, "The Art of Aging." It's nice to have you back on TALK OF THE NATION.

Dr. SHERWIN NULAND (Author, "The Art of Aging: A Doctor's Prescription for Well-Being"): What a pleasure, thank you.

CONAN: You write in this book: Many are the ways of not giving into old age, and they range from the pitiably ridiculous to the helpfully sublime.

(Soundbite of laughter)

CONAN: And you give us plenty examples of both.

Dr. NULAND: Well, I'm more interested, of course, in the healthfully sublime.

CONAN: I'm a journalist. I'm more interested in the pitiably ridiculous.

Dr. NULAND: Well, there we are. That's the difference between a doc and a surgeon.

(Soundbite of laughter)

Dr. NULAND: My sense, and this is the reason I use the word art, my sense is that it can be an art. We argue back and forth about what is meant by art and no one seems to agree. But there are two factors that do seem to be important to all of us, and that is that art must be something that's enriching, art must be something that's creative. And I have felt as I have watched people, when I was in my thirties and forties, who have gotten older, and then myself gotten into my fifties, sixties and now seventies, that, my God, these can be the most enriching years of life. We can rediscover ourselves as we get older.

CONAN: And the critical point you make over and over and over again, aging is not a disease.

Dr. NULAND: Aging is not a disease. Aging is, of course, a perfectly normal physiological process. It is a stage of life. It certainly predisposes us more likely to diseases like malignancies or strokes, or heart attacks or dementias, but those are pathological. And one of the things that I try to point out in the book - in fact one whole chapter is devoted to it - is that what are the differences between normal aging and those things that require some medical attention, because most people don't really understand the differences.

CONAN: So just if you're starting to feel, you know, a particular creak or groan in one of your joints, this is not to say you should accept this as normal. On the other hand, maybe this is something that is - you know, you just have to - you know, this is part of the package if you're 70 years old now.

Dr. NULAND: Well, one of the questions I'm asked most often is what about short-term memory? What about the fact that I can't remember people's names? And of course it's very important to reassure people that these are simply ordinary aging changes and one mustn't become frightened or panicked about them. Ordinary aging does not affect long-term memory. It doesn't affect this great big reservoir that we have experience and thinking about those experiences, reflecting on them, creating what some of us like to think of as wisdom.

CONAN: And of course the problem with memory loss is the terrifying prospect of Alzheimer's disease.

Dr. NULAND: Well, exactly. About 11 percent of people over the age of, let's say, mid-sixties will develop Alzheimer's, but there are very specific symptoms that give Alzheimer's away. And that still leaves 89 percent of people who will not be afflicted by such a dreadful thing.

CONAN: And I was fascinated by a statistic that you list in your book, that the numbers of people in nursing homes is actually fairly small. You admit that there are probably just as many people having the same kinds of problems in their own homes, but nevertheless this is not an inevitable prospect for most Americans.

Dr. NULAND: Well, one - well, not one - but the most important factor that determines whether someone can live at home or has to be in a nursing home is not any named disease but simply physical frailty, that the muscular skeletal system has so deteriorated that people can't get around in their own homes. And the most interesting thing about that is that it's changeable. And geriatricians love to do this experiment over and over again of taking people in their mid-eighties and subjecting them to a program of vigorous weight training, and the result is always the same: Within six weeks, an 85-year-old can double his or her strength and make themselves independent.

CONAN: Vigorous exercise is one of the three lynchpins that you suggest as part of your prescription for aging well.

Dr. NULAND: Absolutely. The other two are equally important, but nothing avails if you haven't kept your musculoskeletal system in some kind of shape so that you can get around and do the things that are interesting and be with the kinds of people that you would like to be spending time with because it's so emotionally and spiritually valuable to you.

CONAN: And spending time with those people, that's another part of the triad.

Dr. NULAND: There it is. In the book I tell the story of having one of my many (unintelligible) sessions with the chief of geriatrics at Yale and talking about musculoskeletal performance and how I go to the gym three times a week and pump iron. He said, yeah, yeah, yeah, but you know that's not the Holy Grail. The Holy Grail is interrelationships with other people whom you value, being needed in the lives of other people. The way I like to put it is looking into the eyes of someone else and seeing yourself reflected there as a person of value.

CONAN: I remember listening to you talk with Robert Siegel the other day on ALL THINGS CONSIDERED. The formula was, if it's a choice between going to the gym or playing with your grandchildren, go see the grandkids.

Dr. NULAND: I'm all for that. And if you don't have grandchildren, my God, there are friends, there are community groups we can belong to. And the significant factor is being part of something, being part of something that in some sense depends on your being there, being needed, having that sense that one or other people really depend on you for something.

CONAN: Let's see if we can get some listeners in on this conversation. We're speaking with Dr. Sherwin Nuland, who's most recent book is "The Art of Aging: A Doctor's Prescription for Well-Being." If you'd like to join us: 800-989-8255, 800-989-TALK. E-mail address is talk@npr.org. We'll begin with Gary, Gary with us from Berkeley, California.

GARY (Caller): Hi, Dr. Nuland, thank you for your research. I just wanted to ask you, I make my living as a horseshoer, and a few years ago I dissected a young horse's foot and saw the changes that came about from incorrect horseshoeing and how the bones actually changed. And it got me to thinking about my own arthritis in my spine. And I thought if I can eat well and practice yoga and get the muscular structure correct, can I correct the arthritic changes in my spine? And I wanted to get your thoughts on that.

Dr. NULAND: Well, I don't know if you can correct the boney changes, but I'll tell you what you can correct. You can correct the muscular changes that are secondary to splinting in one form or another to save your bones. One of the interesting experiences that I had personally was after I started going to the gym about eight years ago. Somewhere about year two I began to notice that all those little cricks in my neck and in my back had virtually disappeared. And there are a lot of reasons for that, but the most important reason is that we can increase our strength very easily just by these resistance exercises. And it isn't so much increasing the amount of muscle as it is increasing the neurological coordination of all of those fibers so they work better together and they're much less likely to put undue stress on the bones and cause the kinds of difficulties in the spine, for example, or shoulders that elderly people are more likely to have.

CONAN: Gary, I have to ask you, is there a lot of work for horseshoers in Berkeley?

GARY: You know, it's a question everyone asks, and most of the work is in Contra Costa County. And frankly, there are more horses in Contra Costa than there are people.

(Soundbite of laughter)

CONAN: Okay, well, thanks very much. Appreciate it, and good luck.

GARY: Thank you, sir. Thank you for everything.

CONAN: So long, bye-bye. Let's see if we can get another caller on the line. This is Roger, Roger calling from the other side of the Bay in San Francisco.

ROGER (Caller): Yes, thank you, Neal, Doctor. I retired very early, 47. I'll be 68 in July. Next month we're leaving for Europe on a vacation. I've done this for years. What I've learned about aging is moderation. Everything should be done in moderation. Don't kill your whole life into golf. Don't throw your whole life into stamp collecting. But do every - just a little bit of everything. One of the things I find so satisfying is simply TALK OF THE NATION, not only listening to it, but occasionally participating on it. It keeps your mind alert. It's certainly not an easy thing to do. Public speaking is one of the most fearful things a person can do, but it's energizing.

CONAN: Yeah, where's that research on TALK OF THE NATION participation, Dr. Nuland?

(Soundbite of laughter)

Dr. NULAND: Well, it's implicit between the lines of the book, Neal. I love the notion of moderation, because, as you know, I put about seven or eight profiles of people who have, well, the term is successfully aged. And one of them is Michael DeBakey, the great cardiac surgeon, who used the term to draw in one's horizons. To try to look at the things that you get the most emotional reward out of, the things that you've always wanted to do but you've frittered your energies away in different directions, things that you might be best at, for example, and this is essentially moderation.

The Greeks used that wonderful term the golden mean, and we've got to be so careful about that now as far as energizing is concerned. This is another DeBakey notion, his notion of looking forward to something that will be interesting to you. It's the anticipation of interest that makes such a difference to older people, whether it's the thought that, oh, my gosh, next week there will be an interesting topic on TALK OF THE NATION and I can do that.

CONAN: Roger, thanks very much for the kind words and have a great time on your vacation.

ROGER: Thank you, Neal.

CONAN: Appreciate the call. We're going to talk - we're going to take a short break. We're talking about "The Art of Aging," Sherwin Nuland's latest book, and, it appears, his own philosophy on getting older. 800-989-8255 if you'd like to join the conversation. E-mail us: talk@npr.org.

I'm Neal Conan. We'll be back after the break. It's the TALK OF THE NATION from NPR News.

(Soundbite of music)

CONAN: This is TALK OF THE NATION. I'm Neal Conan in Washington.

In his new book, Dr. Sherwin Nuland offers up a prescription for well-being. Don't worry about living forever, he argues. Stay active, eat well, have some fun while you're here. You can read more of what he has to say at our Web site. We've posted an excerpt from "The Art of Aging: A Doctor's Prescription for Well-Being" at npr.org/talk. And Sherwin Nuland is our guest today. We ask all of you, boomers in particular, is aging a sentence or an opportunity? 800-989-8255, 800-989-TALK. E-mail is talk@npr.org.

And one of the things you write about, Dr. Nuland, is this expectation that somehow we're at the mercy of the tyranny of the decades, that even though the last morning of our 59th year is not a whole lot different from the first morning of our 60th, there's this perception that we have that something fundamental has changed.

Dr. NULAND: Well, that's right. How old would we feel if we didn't know how old we are? Age has this way of slowly creeping up on us, and most people don't realize they're becoming what's called elderly until - well, in my case, a student said, Dr. Nuland, do you use e-mail? And that was my first clue...

(Soundbite of laughter)

Dr. NULAND: ...that maybe I was looking to him older than I was looking to myself.

There comes a time when you begin to realize your body isn't doing the kinds of things that you were used to. But the interesting thing about that time is that very often your creative juices, your emotional juices, maybe your spiritual juices are flowing more than ever. And one of the reasons for that is that one's occupation or one's profession is not one's identity. And you get a little older, you get into your fifties and your sixties and you start thinking about all the things I've wanted to do that now I can do, instead of being a lawyer or an engineer or a schoolteacher or whatever, and I can express much more of what's in my personality and seek out new ways of doing that.

CONAN: You also point out that we should also act our age, and maybe if one of the goals was to play second base for the New York Yankees, you might want to put that goal aside.

Dr. NULAND: You might not want to do that. There's this wonderful poem by Browning that everybody knows. Grow old along with me, the best is yet to be. And somewhere in there he says: Look not thou down but up. Well, you better look down, because the fact of the matter is, as I reiterate again and again in the book, there are a number of things that indeed do go wrong, no matter how well we take care of ourselves. And we've got to be very careful because we want to make the maximum out of what we have and what our potentiality is.

CONAN: Let's get another caller on the line. This is Doug, who's calling on our international line from Germany.

DOUG (Caller): Yes, good evening.

CONAN: Good evening.

DOUG: I'm calling simply because I was fascinated with your comments about activity as far as the muscle training.

Dr. NULAND: Yes.

DOUG: And I have a living example. My father will be 98 in April. Ten years ago, he started on a - he started doing some muscle training because of an article I sent him, I read in the paper. And he lives in Philadelphia, by the way, in that area in the States. And he started doing then three-day-a-week workouts with Nautilus equipment and bicycle and walking one and a half miles a day, or whatever, just as part of his normal way of life. And he recently sustained, unfortunately, broken bones in his back as a result of a fall. He was paying too much attention to his lady friend going downstairs and missed them.

(Soundbite of laughter)

DOUG: And as a result, though, his recovery has been amazing.


Dr. NULAND: Well...

DOUG: Even at that age.

Dr. NULAND: I'm so glad...

DOUG: It's taken a longer time to get back, but, you know, he's...

Dr. NULAND: Sure.

DOUG: It's only because of the muscles that have built up that he's much more resistant to those types of injuries that affect older people and really, you know, cause them to end up in wheelchairs.

Dr. NULAND: I'm so glad you brought that up, Doug, because that's one of the most important things about increasing your muscular strength. We have these preconceptions, these images that in fact older people cannot build their strength up, and all of these experiments that show that people in their mid-eighties can double their strength within six weeks. And the major virtue of that is not only being stronger but being able to recover from these kinds of injuries more quickly. When older people who have been doing weight training fall, they're more likely to be able to control the fall that they have. So we've got to throw out these old preconceptions that we've all grown up with, and that's where we're counting on the boomers.

DOUG: Exactly, but I don't want to waste any more time on the show. But I just want to say he's a living example, and I can only say to everybody else getting in that age, or even before that, start sooner and just do a regular workout, and that'll help going forward.

Dr. NULAND: Well, there it is. Largely what we are in our eighties is a trajectory - continuation of a trajectory of what we started in our forties, but it's never too late. It's a good thing to begin early, but you can begin (unintelligible).

DOUG: Last thing I want to say is he's a Yale graduate.

(Soundbite of laughter)

Dr. NULAND: Well, we'll try not to hold that against him.

DOUG: And unfortunately, at the opposite end of the thing is that his class, there's too few people there for a reunion, so he ends up going to George Bush the first's reunions.

Dr. NULAND: Well, we should talk about that specifically, because there's this huge study that was done on students from the University of Pennsylvania and Harvard over a 50-year period. And it turns out that people who have used - and the exact figure is 2,000 calories per week - more than their classmates can postpone disability by an average of seven years.


Dr. NULAND: And one of the secondary importances of that is that you realize that nature is less important than nurture as we get older. So this crosses all DNAs, everybody's genetic predisposition, and yet they do better if they do this kind of exercise.

CONAN: I was afraid you were going to say the study of all these people at Penn and Harvard, it turned out that they had really wanted to go to Yale.

(Soundbite of laughter)

CONAN: Doug...

DOUG: (unintelligible) So my father's DNA is in me. I'll let you go. Other people want to call, I'm sure. Thank you very much.

CONAN: Thanks very much for the call, Doug. Here's an e-mail we got from Jean(ph) in Madison, Alabama. And the current outrage of the hour is the mugging of a centenarian in New York City. I was very impressed to see a lady who was not bound to a wheelchair, as I typically see on the news, but a lady living independently and actively. And I was left wondering how she accomplished this. This is the lady who fought back against her mugger.

Dr. NULAND: Yes, I actually saw those videos, and the remarkable thing about the videos was that they were taken just a few hours later and she didn't seem to be badly injured. And I'm going to guess, without knowing, that this woman pursued a very vigorous life, that she had just come in from shopping, for example. How many 101-year-old people do you know do their own shopping? So it was a question of body and mind at the same time. How articulate she was in describing what happened to her.

CONAN: Here's an e-mail from Ted in Oakland, California. Hopefully you can take some time in your program to talk about efforts to extend our lives. Aging is a disease which can be cured, he says.

Dr. NULAND: Well, every species of course has its own species-determined life expectancy. Ours is probably about 120 years old. In the book there's a chapter about a couple of days I spent at the University of Cambridge with a molecular biologists who was determined that he has figured out why cells age. There are seven reasons, and he's got a response to every reason. And if he gets $100 million, why, he'll have us living 5,000 years, and during that time there'll be more research so it'll be 10,000 years.

And this brings up the whole issue of should we be attempting to extend life beyond the normal species-determined level, or should we be spending most of our time, most of our effort, most of our money on what the geriatricians call compression of morbidity, making the years that we have, up to 120 hopefully, as good and strong and rewarding as possible? Geriatricians are attempting to extend our length of life within the normal species determination, but to make those years so good that instead of slowly declining and getting sicker and sicker over 10 or 15 years, that decline happens in the last couple of years and the rest of it up until then is vigorous, rewarding and fun.

CONAN: And this a question, an e-mail question from Michael(ph) in Burlington, Massachusetts. What about caloric restriction? It seems to do well for mice and some of us really hate exercise.

(Soundbite of laughter)

Dr. NULAND: Caloric restriction has been shown repeatedly in mice to increase lifespan perhaps by as much as a third. The problem with all of this kind of thing is that, if you try it with human beings, it's virtually impossible to follow. Actually, I recently saw a video with a couple who had calorically restricted for three years. It wasn't just that they were skinny and listless, but they found it necessary to let everybody know how vigorous they were when clearly they were not vigorous. This is an awful way to spend your life. But I do recommend caloric restriction within reason. Now Michael DeBakey, who is - you know, he's in his seventies - nineties, I'm sorry, he's 97 years old - when I had dinner with him or lunch with him, he ate about a third what I did. We should eat for hunger and not for appetite. That makes a big difference.

CONAN: Easier said than done.

Dr. NULAND: Yes, yes, yes.

CONAN: Let's see if we can get another caller on the line. This is Claudia. Claudia with us from Denver, Colorado.

CLAUDIA (Caller): Yes. Thank you so much for taking my call.

CONAN: Sure.

CLAUDIA: And Dr. Nuland, I have enjoyed so many of your books.

Dr. NULAND: Thanks.

CLAUDIA: So it's a pleasure to get to speak to you. I have a chronic disease. I'm 59 years old and I was diagnosed at about the age of 47 with multiple sclerosis. And I actually had onset of symptoms beginning about two years prior to that. And I had always been an extremely active person, watched my diet, walked 35 miles a week, did aerobics, did yoga, did qigong. I mean, you know, the whole gamut - weight lifting.

And at this point I am in a wheelchair. I have virtually no use of my legs. I do try to do upper body exercises on a regular basis. And I think your philosophy is wonderful, but what do you do with somebody such as I?

Dr. NULAND: Well, you know, one of the things I did in the book was deliberately seek out people who had taken some very hard hits.

CONAN: I immediately think of Patricia Neal in this kind of discussion.

Dr. NULAND: Exactly. Thirty-nine years old, had a massive stroke. The newspapers reported that she had died. And, of course, she's got considerable disability from all of this kind of thing. And what I discovered talking to people who had been hit as hard as you have, Claudia, is that it wasn't so much the disease they had or the tragedy in their own lives but the response to it.

And, of course, our lives are cut short by dreadful problems like multiple sclerosis and others. But again, you know people with multiple sclerosis who don't have the outlook on life that makes you, for example, say gee, I've been reading your books and I like your books or calling in to TALK OF THE NATION.

There you're telling us essentially that your vitality, your intellectual vitality, you interest in life has remained just what it would be if you were perfectly healthy. And yet you've got this dreadful problem to live with. So there are factors that may not be very good physically, but never the less spiritually and emotionally may even enrich us even though we've got those problems that are changing the course of our lives and the length of our lives.

CLAUDIA: And I'm not concerned about the length of my life. I just - what the problem is is that I would like so much - and I do volunteer work for a number of organizations and that kind of thing. And I do read as much as I can, although that's become very difficult. It used to be a passion, but now I have a great deal of problem with my eyes, again, caused by the MS. And, you know, I try to focus on the quality and stay engaged with everything that's going on around me.

CONAN: Sounds like that pretty well fits the prescription.


Dr. NULAND: That is the prescription. I think it was Montagne(ph) who said it's not the length of the candle, it's how brightly it glows.

CLAUDIA: Right. Okay. Well, thank you very much.

CONAN: Claudia, good luck to you.

Dr. NULAND: Thank you.

CONAN: Thank you very much.

CLAUDIA: Thank you. Bye-bye.

CONAN: We're talking with Dr. Sherwin Nuland about his most recent book, "The Art of Aging: A Doctor's Prescription for Well-Being." You're listening to TALK OF THE NATION from NPR News.

And let's see if we can get Richard on the line. Richard with us from Maricopa in Arizona.

RICHARD (Caller): Hi, Neal.

CONAN: Hi, Richard.

RICHARD: For your guest, I wish that he would please comment. I'm 65 years old. My wife is 10 years younger than myself, and she's a disciple of Diane Summers most recent books on hormone therapy. And Diane Somers addresses hormone therapy for men, as well as women. And my wife is constantly prescribing to me from the material that she's absorbing. And I'll take your comment off the phone and on the air.

CONAN: Okay, Richard. Thanks very much.

RICHARD: Thank you.

Dr. NULAND: Well, this is a problem. For example, I'm assuming that the hormone therapy she's referring to is something of a testosterone derivative. It's scary. It's dangerous. We know that the frequency of men who eventually develop the very common disease of prostatic cancer is sufficiently increased that most doctors - most doctors with experience, with knowledge would not recommend that kind of hormone therapy for men.

We have no idea of long-range effects of steroids and other hormones in men. It's an absolutely blind area. It frightens me. I don't take any at all. And considering the fact that statistically 60 percent of men in their sixties have microscopic prosthetic cancer that never manifests itself, I don't think it's a good idea to run the risk of activating that kind of microscopic change with any hormone therapy whatsoever.

And growth hormone is in the same category, as far as I'm concerned.

CONAN: This comes under the category of - without meaning insult to anybody -but panaceas.

Dr. NULAND: Panaceas and artificial enhancements. Nothing in this book talks about artificial enhancements because I'm not a great believer. I'm a great believer in the enhancements that we produce by our physical activity, by our mental creativity, and most importantly, I think, by the kinds of relationships we have with people, by the sense of being part of a community, by being needed by others.

CONAN: Here's an e-mail got from Michele.

In more forties, hit by a truck while on my bike. Two broken legs, healed with a deformity, developed Graves, developed advanced esophagitis and fructose intolerance and finally IBS. I will take my wrinkles and flab any day. I walk 10,000 steps every day. Average 20,000 on the weekend. I work out every other night with weights and do sit ups.

I'm determined to feel good day by day. When afflictions happen before the aging process sets in, then believe me when I say my age-related aches and pains are a welcome change to my other problems. I'm proud of fighting every day to feel good and sometimes I even succeed.

I may be slower at my tennis game and my time for walking a mile is slower than it was, but I enjoy the challenge of aging. And I like the way my face is showing my life's experiences.

We'll have more with Dr. Sherwin Nuland when we come back from a short break. It's the TALK OF THE NATION. If you'd like to join us: 800-989-8255, 800-989-TALK. E-mail: talk@npr.org. You're listing to NPR News.

(Soundbite of music)

CONAN: In a few minutes we'll be talking about the decision of a popular celebrity gossip Web site to come to Washington D.C. And we'll wonder: Why? Right now, though, we're talking with Dr. Sherwin Nuland about his new book, "The Art of Aging." You can read an excerpt at npr.org/talk. And let's get another caller on the line. Catherine is with us, Catherine calling from San Francisco.

CATHERINE (Caller): Hi. I agree with everything you're saying about keeping physically and mentally fit. I started working out in my thirties, and then I started riding motorcycles when I was 50. I'm 58 now. I ride a Harley. And I also finally got my degree, my BFA from the San Francisco Art Institute, and now I'm working on my master's. So, yeah, life goes on.

CONAN: And how's the riding going, Catherine?

CATHERINE: Oh, I did crash once and the ground is really, really hard. But I bounced right back and it's something that I really, really want to be able to do.

CONAN: And your master's, what are you studying?

CATHERINE: Painting.

CONAN: Painting? Dr. Nuland?

Dr. NULAND: Yes, painting. Well, first let me say that what we are in our seventies and eighties is the trajectory we started in our thirties and forties. And this is why I aim so much of this book at the boomers. And once again, it's never too late to start. But the trick is really to begin early so that you are a person who is just accustomed to thinking of life and thinking of one's body in this particular way.

I'm fascinated by the painting, Catherine, because in the book I tell a story of visiting a home for the elderly. Two thousand people were there - outside of Paris in one of those little villages that they always called (unintelligible) or something like that.

And being introduced to the director of psychology who, when he first got there, I believe it was 15 years ago, invited a number of Parisian artists to come in and teach painting to the people who lived there, most of whom - almost all of whom had never painted before.

Fifteen years, he had a collection of 40,000 paintings because he had convinced the administration to create little studios. So if you wanted to wake up at three in the morning, you had a key to your studio and you can work on your painting. And I saw a few hundred of them.

And I must tell you it brought home to me the importance of what this man, Rene Le Forestier(ph) was talking about, which was creativity. Creativity becomes such an important thing as we get older. The notion that you're learning something new and everyday you're a little bit better than the way you were before. And it gets back to this other notion of the anticipation of something interesting tomorrow.

CATHERINE: Oh, boy. That's true. I'm looking forward to my MFA, and I'm also studying Italian. And when I graduate, I hope to be able to take classes over there. But now, you just gave me a great idea about helping the elderly in - of course, I'd be elderly, too - help the elderly in Italy. That'll be fun.

Dr. NULAND: Well, that's right. This isn't make work. You know, it isn't little artistic stuff. It's serious work teaching people to paint.

CONAN: Catherine, good luck.

CATHERINE: Thank you. Bye-bye.

CONAN: Bye-bye. Let's see if we can get Mel on the line. Mel's with us - well, seems to be on I-94 between Chicago and Detroit.

MEL (Caller): Hello, Dr. Nuland. I'm happy to speak with you.

CONAN: And turn down your radio, please.

MEL: Yes. My wife and I are driving to visit my mother whose 101st birthday is tomorrow. She lives by herself. She has aides coming in several mornings a week. There's no hint of dementia in her, but she is wooly, she is a little forgetful, and far more literal minded than she used to be, lost the capacity to metaphorize, I guess.

And I guess my question is what is reasonable to expect. I would assume that if there's no dementia that has appeared so far, it is unlikely to be. She used to be a piano teacher and still plays every day and keeps herself occupied with crossword puzzles and little manual projects and can carry on a terrific conversation for a while. But as I said, she is forgetful and is just far more literal and somewhat nervous. And I guess what can I expect?

Dr. NULAND: Well, in the first place, forgetfulness, you know, is not pathological. It's a normal aging change, and one of the things I do in the book is differentiate between what normal aging changes are and what the things are that we have to worry about.

We've discovered - and this is fairly recent, the last five or 10 years - that the brain determines its own aging. The strength of the synapses, or the connections between cells - the amount of neurotransmitter, the liquid, we'll call it a liquid chemical - that carries the messages from one nerve cell to another, the amount of blood supply is actually determined by how much we use our brains.

MEL: I'm sorry, I didn't hear the last thing you said, sir.

Dr. NULAND: I say that all of these factors, the strength of the transmission of the nerve impulses in the brain, even the blood supply to the brain, even the creation of new cells because stem cells create new cells in the brain. We never knew that until five or 10 years ago. These are determined completely by how much we use our brains.

The brain is essentially plastic in the sense of changeable. And if you don't use it - well, there's Ann Landers. You lose it.

CONAN: Mel, drive carefully. And have a good time with your mom.

MEL: Okay. Thank you very much.

CONAN: So long. Here's an e-mail from Helen in Casper, Wyoming. Could your guest please talk about massage and the effect it has on fighting stress tearing away at the body over time?

Dr. NULAND: Well, my sense of massage really is that it's something emotional and psychological. Our state of mind, our feeling of well being becomes a determinant of how much we actually do to increase the well-being. The person who has a sense of vibrancy about oneself is the person who is more likely to exercise, the person who's more likely to go to a museum and tax their intellect or decide oh my God, I've always wanted to read Dickens. Let me read 10 of them in a row.

So I'm all for anything whatsoever that makes one feel better about one's state of corporeal - if I can use that word - vitality.

CONAN: There's also - you mentioned this in passing earlier - the nature-nurture element of this. To what degree to benefit from any of this prescription must we be winners of the genetic lottery?

Dr. NULAND: Well, of course, it helps to win the genetic lottery, but biology is not destiny. We've known that for a long time. And there's no question that as we get older, how you've maintained the machinery is much more important than the machinery you were granted in the first place.

We older people have to become what I call philosophers of aging. We don't get as many second chances as we did when we were 30 or 40 or 50, so it behooves us to do the things that keep heart, muscle, brain in good condition, whether or not we're endowed by our DNA.

CONAN: So a properly maintained Yugo will do just as well as, perhaps, a Mercedes that's been left and neglected?

Dr. NULAND: Well, the proof of all of this is these huge studies of men - the Penn and Harvard one, for example - were it makes no difference what genetic background is. If you do a certain amount of exercise, your life span will be increased. Your vibrancy and strength will be increased. And the most important thing - once again - is this is not genetic. This is something you've done for yourself.

CONAN: Let's see if we can wind up - last call, Bob. Bob's with us from Cleveland, Georgia.

BOB (Caller): Hello.

CONAN: Hi, Bob.

BOB: I'm a World War II veteran who got shot at by the Koreans before they actually started the war. I've been lucky, is what I'm getting at.

CONAN: Yeah.

BOB: And I got very much more lucky than I'd been all my life when I came to Georgia, 1973, met a guy who said he believed in holistic medicine rather than chemical warfare, put me on to Vitamin C, which I've discovered helps my entire body. I don't ache in my - any joint anymore. I'm now 78, so that's, you know, better than average, I believe.

My reflexes are as good as any teenager's, and this year I'm going to try for the land speed record in Bonneville. I've been racing sports cars 50 years come this month, actually.

CONAN: Well, good luck with that, Bob.

BOB: And the object is I exercise, I take my vitamins and I have no problems. My medical doctor says I have a benign history. That's what he wrote in the medical check I just - you know, just completed because my racing driver's license was up for removal.

Dr. NULAND: Well, you're doing all the right things. I have to confess I'm hooked on Vitamin C myself. I discovered it when I was working…

BOB: You don't have colds. You don't have all sorts of maladies that everyone else gets.

Dr. NULAND: There it is. I never have colds. As soon as I get a little bit of a cold, I start pouring the Vitamin C down my throat, and…

BOB: And also, I had a damaged knee in 1984, discovered that the Vitamin C taken in large quantities - turned out to be about 3,000 milligrams a day -kept the joint from hurting. And to this day it does not hurt if I take the Vitamin C, and it does if I don't.

Dr. NULAND: Well, you may meet some doctors who tell you not to go above 2,000, but it seems to work for you, so don't do anything differently.

CONAN: And Bob, maybe it's that need for speed that keeps everything working properly.

BOB: Well, it must be, because that helps, and my crew chief in our Bonneville efforts says whatever you're doing, keep on doing it.

(Soundbite of laughter)

CONAN: You bet, Bob. Congratulations, and get the record and call us back, okay?

BOB: But everything that this man is talking about is part of my regime. That's what I'm getting at, really.

CONAN: All right.

BOB: Everything he's recommended is in addition to what I'm doing.

CONAN: Okay, thanks very much for the call, and again good luck to you.

BOB: Okay.

CONAN: And Dr. Nuland, thank you for your time today.

Dr. NULAND: Oh, what a pleasure.

CONAN: Sherwin Nuland is the author of, most recently, "The Art of Aging: A Doctor's Prescription for Well-Being." He joined us today from our bureau in Chicago. You're listening to TALK OF THE NATION from NPR News.

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