Empowered by having real tools, the kids went to town. We next moved on to kale, the much-maligned hipster green. But we were going to do something a little different here. Do we eat flowers? When the kids looked confused, she said, We can eat these! Pick two yellow kale flowers and put them in the bucket. One thing that is especially exciting about this 2019 research out of Okinawa is that it wasn't done on rats or mice but was actually conducted with humans. These aren't hypothetical human effects; I look forward to more of this type of research. Besides this specific research study, scientists all over the world are reporting findings related to fasting and longevity. Here is just a small sampling of some recent findings: As we get older, the mitochondria of our cells lose the ability to process energy efficiently, which leads to both aging and age-related diseases. Our cells also lose the ability to dispose of junk proteins, and this can lead to the accumulation of excess proteins that lead to the development of diseases such as ALS (amyotrophic lateral sclerosis) and Alzheimer's. In 2017, researchers from Harvard University reported that both exercise and fasting (even for brief periods) enhance the cells' ability to dispose of some of these junky proteins that cause diseases by enhancing the function of our mitochondrial networks. One of the scientists involved in this research referred to it as turning on the cellular vacuum cleaner, and I love to think of my body vacuuming out the junk during my daily fast! We know that as we age, we become more susceptible to maladies like cardiovascular disease. I start sweating and stammering. I think they're immediately turned off. I've only gotten to a second date once in my life. She seemed as nervous as I was, but after that second date, she never texted me back.

When I have a fair amount of alcohol in me, small talk is easy. Women don't seem to expect you to have a meaningful conversation at a bar. That's where I'm most comfortable. A few drinks in, I'm not worried about how women perceive me. I mean, who cares, right? I'll never see them again. Community-based care has not adequately filled the void. There are only 28,000 psychiatrists in the United States. The number is declining, as most are over 55 and beginning to retire. There are about 100,000 psychologists and about 125,000 mental health and substance abuse social workers. Projections show a significant growth in the demand for all types of mental health providers over the next decade. Indeed, the rising opioid and substance abuse problems in the United States has further exacerbated the need for mental health providers. One consequence is that only about half of all adults with serious mental health needs actually receive services. Another consequence is that many patients with mental illnesses now end up in prison; There has been a growing appreciation for the role of depression and anxiety in the management of patients with chronic illnesses, such as diabetes and cancer. Studies have shown that about 25% to 33% of patients with chronic illness or those admitted to a hospital for medical reasons or surgical procedures have comorbid depression and anxiety. So while women who received estrogen did prefer not to have hot flashes, sleep disturbances, and other distressing symptoms of menopause and liked some of the positive effects, such as improvements in their skin and prevention of colon cancer, the estrogen replacement was harmful in terms of protecting against some major age-related diseases. Since the publication of this study, other studies have reported a decrease of up to 25 percent in the incidence of breast cancer in the United States. Declining estrogen and resultant menopause appear to be protective against aging, and if that's true, averting these conditions is the wrong thing to do. By the way, the same goes for declining testosterone in men--replacement therapies among men with very low testosterone improve some symptoms but increase the risks for other conditions.

In fact, the risk-to-benefit ratio led doctors to stop recommending it even to men who are highly deficient in testosterone. People who had been staunch believers in hormone replacement therapy were shocked by the results of the WHI study and are looking for windows of opportunity where the treatments will have the desired effects without doing harm. There are studies that suggest there may be a time frame between ages fifty and sixty when hormone replacement therapy could be beneficial, but as I explained earlier, estrogen appears to be a hormone that is beneficial in young women but harmful in older women, so we still have a lot to learn. And since people biologically age at different rates, we would need to pinpoint the right time frame for each person. Beyond that, even if we can provide the therapy during the optimal period, the benefits may end shortly after that time frame ends. The WHI was a billion-dollar study that was controversial from the start. They smiled--they definitely knew how to pick flowers. We weren't going to pass by the strawberry patch without stopping. Each kid plucked a strawberry and put it in the group basket. While most of the kids weren't tempted by the spinach or lettuce, the prospect of fresh-picked strawberries was alluring. A few, including Dylan, almost had the fruit go in their mouths before the instructor said we were collecting them for the group. While we would be eating them eventually, the kids would have to wait. Last were the peas. The children had to show self-control here too. The instructor gave them permission to eat one single pea pod--no more. Throughout the process, I saw the kids demonstrating many of the emotional and social skills that can be gained in the garden, from cooperation to independence. Vascular aging plays a significant role in this process, as the vessels become sensitive and more subject to damage over time. In 2018, researchers at Georgia State University identified a molecule with antiaging effects on the vascular system. They believe this may help us keep our blood vessels young and healthy. I love the sound of that!

As we age, our intestinal stem cells lose their regenerative abilities, and it takes longer for the intestines to recover from infection or injury. Biologists at MIT found that a twenty-four-hour fast can reverse age-related loss of intestinal stem cell function. As a result of the metabolic changes, they saw enhanced function and cellular regeneration. While we can't see inside our intestinal tracts, I love the idea that the lining of my intestines is youthful and strong. In 2018, researchers performed a comprehensive review of the scientific literature on fasting. In their paper, they examined both time-restricted eating (the eating-window approach) and various alternate-daily fasting strategies (the up-and-down-day approach). I've actually started back at the bars. I think I'm gonna cancel my online dating apps. I might not be cut out for a relationship. Maybe I should just accept that and give up. Though he was a bit misguided, I gave kudos to Pete for the attempt to challenge his brain's false fear messages by going on dates. I reiterated that, through avoidance, he had long ago taught his brain that dating and intimacy were dangerous. I then asked Pete how long he had been dating with the goal of working toward a relationship. Resigned, he said, Over two months, with about one date every week. So, maybe eight dates. So much for commitment! Having comorbid mental health conditions substantially increases health care costs, often by 60% to 70%. New efforts are being made to routinely screen patients for depression and anxiety and rapidly link them to mental health care. Some of the new models of care involve routinely screening patients in the hospital and office setting and embedding mental health providers in primary and specialty care offices to support these patients. In addition, start-up companies are trying to address the demand through linking patients with mental health providers online to improve access and regularly assess patients to track their improvement and the mental health providers' performance.

Long-Term Care There are about 50 million Americans 65 years and older. Over the next 2 decades this number will grow by 50%. There is a high demand for long-term care but limited supply. Approximately 1. In addition, there are 1 million Americans in assisted-living facilities, and this number has been rising. Many scientists and clinicians asked why it was necessary to spend so much money on a clinical study when there was already strong evidence from association studies. They had concluded from those studies that there was evidence that although estrogen carries a risk of thrombosis and strokes for some women, it does many good things for postmenopausal women, chief among them clearing the symptoms of menopause--hot flashes, sleep disturbances, mood changes, and vaginal dryness. Some animal models--most of them mice or rats that were supplemented with estrogen or a placebo after having had their ovaries removed at a young age--supported the notion that estrogen has positive effects. While many of the women who had been taking estrogen saw improvements, it was because they were taking very good care of themselves in other ways, not because they were receiving estrogen. Many women on estrogen were exercising regularly, did not smoke, took vitamins and supplements, carried less excess weight, and had healthier lifestyles in general than the women who were not taking estrogen. Admittedly, they also took estrogen very early on, rather than starting to take it in their sixties, and that may make a difference. The WHI, on the other hand, was a clinical study (ie, some patients received placebos), and it was also double-blind, meaning that neither the doctor nor the patient knew their assignment. And this kind of controlled study is the only kind of study that can specifically determine whether a drug works. In the case of estrogen, there's no doubt that it has a youthful effect on a young body, but the question was, can it restore youthfulness to an old body? And the answer is no--an answer that had to come from a double-blind clinical study. Gardens always provide a new and novel way for children to work together, said Studer, referring to the students visiting the Youth Garden. There's always this informal negotiation that happens because this is a novel space to them. Cooperation made picking greens for the entire group take much less time than if one person did it alone. Taking only what they needed that day, not eating the peas, and even staying on the paths required a level of serious self-control from such young children.