Ages 50-65 years

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Diet:

A personalized diet plan is recommended. Among several, a whole foods mostly Plant based diet, Cardiometabolic diet or Mito diet provide the most benefits in terms of reducing inflammation, detoxification and achieving hormone balance. At this age, hormone imbalance usually progresses to advance level. Women go through menopause phase and men see a decline in testosterone levels. Following diet related strategies can help achieve balance,

• A whole foods plan based diet helps promote phase 1, 2 and 3 detoxification pathways in the liver and helps achieve hormone balance.

• Micronutrients such as zinc, magnesium, folate and several vitamins which support hormone balance can be obtained from green leafy vegetables.

• Avoidance of processed foods such as packaged meats prevents metabolic and endocrine derangements. 

Exercise:

At this age, we start to lose flexibility and accumulate disproportionate distribution of fat or adipose tissue. This is often seen as belly bulge, neck hump, and loss of core strength. Therefore, an exercise plan must be followed consisting of > 150 minutes/week of exercise including  focus on toning, strength training, cardio, yoga etc.

Screening and Age Based Evaluation:

• Age appropriate cancer screening includes yearly mammogram and a pap smear in women every 3-5 years. Prostate cancer screen when indicated in men and colon cancer screen in men and women starting at age 45. In addition, bone density scan (DEXA) is indicated in women. 

• Age appropriate immunizations.

• Metabolic, cardiac, hormone and additional evaluation based upon individual symptoms: When evaluating for the above, following must be considered, ​

  • Most common cardiac risk and disease in this age group includes atherosclerosis from years of accumulated high cholesterol and consumption of inflammatory diet. Cardiac function starts to decline and this leads to symptoms of heart failure such as fatigue, shortness of breath, leg swelling and chest heaviness. In addition V02max, which is a marker of cardiorespiratory fitness declines. Lung function testing in the form of spirometry and additional testing may be of value when this is suspected. 

  • Common metabolic conditions include diabetes and related complications start to develop because typically by now, people have lived with high blood sugar for several years. Some of these include,

    • Neuropathy 

    • Eye disease and

    • Decline in kidney function 

  • Additional common problems include gout and non-alcoholic fatty liver disease. Excessive alcohol intake in preceding years further exacerbates this condition. 

  • Most common marker of inflammation are elevated CRP and elevated homocysteine. In addition, autoimmune diseases start to manifest themselves due to epigenetic expression of a variety of genes. 

  • Immune system starts to lose its robustness and ability to fight infections. This leads to resurgence of chronic viral infections. Common viruses which tend to persist in body include herpes zoster or shingles, herpes simplex etc. 

  • Digestive and absorptive capacity can start to decline in this age leading to a variety of nutritional deficiencies including vitamin D,B vitamins, and minerals such as magnesium etc. This leads to fatigue and inability to lose weight. In addition, loss of smooth muscle tone and mucosal damage from age related changes leads to a variety of common disorders such as GERD and functional bowel disorders such as SIBO, leaky gut and IBS. Gut evaluation, therefore can help identify some of these problems. 

  • Most common female hormone imbalance at this age includes decline in estrogen and progesterone and testosterone with a parallel rise in cortisol levels. Approximately 40-60% men experience low testosterone levels in this age group. Hormone evaluation in the form of lab testing helps identify needs for hormone based treatment. 

Work evaluation:

• By this age, years of physical stress from high risk jobs usually has accumulated and leads to medical conditions such as arthritis, mood disorder and overall deconditioning. Usually people have reached peak of their careers by now which comes with added responsibilities. Many people work outside their work hour windows which leads to stress, sleep disturbances and a compromise in quality of life. Identify and modify work related stress on physical and mental health. High risk jobs include,

  • Sit down desk jobs​ 

  • Strenuous and repetitive physical work

  • Work with toxin exposure such as dental hygienist, factory and farm workers, building rehabilitators etc. 

  • Night shifts which can disrupt circadian rhythm

  • Work which involves potential conflict related to human interactions such as human resources, customer service​​

  • Any work with profession-passion dissonance

Sleep:

• A good quality 6-8 hours of sleep is important. Obstructive sleep apnea affects approximately 25-30% population in this age group. Being overweight or obese further increases the risk. Therefore, when suspected, this condition must be evaluated and treated.

• Disturbances in initiating and maintaining sleep and circadian rhythm disorder starts to develop and at risk individuals report difficulty falling or staying a asleep. Decrease in body's ability to metabolize caffeine and other stimulating products leads to further sleep disruption specially when these products are consumed to stay awake and to function. Thus a vicious cycle of non-restorative sleep and fatigue develops leading to a variety of metabolic derangements and even cognitive decline. 

Genetic testing:

• Genetic testing is indicated based upon family history and/or specific clinical markers. Specifically, genetic tests for the following may be of value,

  • Alzheimer disease ​

  • Cardiovascular disease

  • Cancer screen 

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