Health Seminar to Give the Power to Live
September 8, 2018
The importance of "healthy aging" and prevention
-My experience with 105-year-old Dr. Shigeaki Hinohara at the final moments of his life-
St. Luke's International Hospital Director
Dr. Tsuguya Fukui
【Dr. Nobuaki Shikata, The director of Izumiotsu City Hospital Laboratory and Pathology Center】
Today’s speaker is Dr. Tsuguya Fukui, who is the director of St. Luke's International Hospital. I will first present a brief biography of Dr. Fukui. After graduating from Kyoto University School of Medicine in 1976, he trained at St. Luke's International Hospital for about four years. Subsequently, thanks to a recommendation from Professor Hinohara, he studied abroad in the US at Columbia University and then Harvard University's Public Health Graduate School. He then returned to Japan, where he became an associate professor of the General Medical Department at Saga Medical University Hospital in Kyushu and then became a professor.
I had something of a relationship with Dr. Fukui at that time. While I was at Kansai Medical University, a workshop-type program was held for the education and training of students every summer. We invited Dr. Fukui to that program while he was a professor at Saga Medical University.
Dr. Fukui later became the professor of the General Medical Department of Kyoto University, a position he held for 10 years. Since 2005, he has served as the director and board chairperson of St. Luke's International Hospital and the President of St. Luke’s International University.
After working for about 20 years at Kansai Medical University, namely when I was 60 years old, and I was then assigned to join the doctor training course. It was at that time that we invited Dr. Fukui to join our staff.
Dr. Fukui attends this camp every fall. On one occasion, Director Ishigaki asked, “I would like to speak with Dr. Fukui. Do you have any suggestions, Dr. Shikata?” Believing there was a strong chance Dr. Fukui would visit Kansai Medical University again that October, I spoke with the general affairs section manager and was told that Dr. Fukui would indeed be in attendance, so asked him if he might be free to talk to Director Ishigaki at the time. Let’s hear from Dr. Ishigaki about why he wanted to speak with Dr. Fukui directly.
【Dr. Kunihiko Ishigaki, the Director of Tamago Building】
Our story begins when I was thinking about how to make use of the wonders of modern medicine or how to solve problems plaguing modern medicine. Tamago Building holds the philosophy that "People were born to enjoy things." This means that, considering the creation of the universe and the earth itself, the birth of creatures and the advent of the human race, we are truly blessed; our very existence is a miracle. I thought about how we should live. Although there are various hardships in society, we humans are a privileged species. I therefore concluded that humans are born to enjoy life after all. Given my position in the field of medicine, I decided that I wanted to create a society that fostered the realization that we are born to enjoy life from the medical field, and to contribute in this way.
Being able to heal diseases is a wonderful thing. However, their prevention is more important for allowing people to enjoy life. Expanding on preventing, we concluded that we ought to aim for living a healthy life overall. I was wondering whether there is any principle that can be applied to allow life to be lived smoothly from birth to death. I found that if one can establish a state in which the body structure moves smoothly, then this can happen. One person who triggered this realization was Dr. Tsuguya Fukui.
The trigger was the November 2005 issue of the scientific journal Newton, when a reporter asked Dr. Fukui, "In the 21st century, when molecular biology is at its peak and science seems able to solve any problem, why are guidelines established based on the data of randomized controlled trials with high medical credibility grades?" In response, Dr. Fukui said the following:
“To put it briefly, I think that such an endeavor will show us that we do not yet understand the entire picture of a person.”
“Because of environmental issues and the complexity of the human body, we cannot always predict what changes will occur in the human body in response to certain elements.”
Therefore, when judging the effectiveness of examinations and treatments in medicine, "We must put everything between the cause and the result into a black box and then assess the efficacy using statistical methods.”
When I read this article, I first thought how we can grasp the whole picture of a person. Secondly, I thought that we should be able to identify the changes in the body that take place when a person is presented with physical or emotional adversity. Doing so will allow you to grasp the facts concerning the cause and result in a graceful way, and to clarify the progress and course, which will then allow you to deal with the issue. Therefore, from the January 1, 2006, issue I decided to have a column on the topic of health serialized in the Kawachi newspaper; I just published my 139th column in the most recent issue. I was given a placement on the front page and dealt with many doubts. One answer I arrived at by writing this column was that we can obtain an overall view of a person, and assess the changes and progress of a human body based on the flexibility of the upper abdomen.
I applied these findings to clinical practice and intertwined them with modern medicine examinations and diagnosis approaches. Furthermore, incorporating the diagnostic methods of eastern medicine can clarify more things. A soft upper abdomen is a key indicator that a patient is doing well. Even in nursery school children, a soft upper abdomen indicates good health, while a stiff upper abdomen preludes poor growth. Flexibility of the upper abdomen and modern medicine facilitate the prevention of disease, precise treatment and a gentle death.
The health seminar on July 14th was about how to prevent long-term care. Patient A told us about his experience of caring for his wife. Patient B told us about her experience of taking care of her husband in the last moments of his life as he was dying of terminal cancer. Patient A’s wife stopped complaining of pain after we treated her. We also treated Patient B’s husband until the last moment and he did not feel any pain. Dr. Fukui thus took the opportunity to fill the hole into which modern medicine was falling by making use of the splendors of modern medicine.
I’ll now turn the floor over to Dr. Tsuguya Fukui.
【Dr. Tsuguya Fukui, Director of St. Luke's International Hospital】
Thank you for your introduction. I’m Dr. Tsuguya Fukui. My story is divided into four parts.
1. Dr. Hinohara’s short "later years"
I’d first like to talk about Dr. Hinohara, who lived to be 105 years old. I’ll touch on how he lived, what he said, and what kind of things we have learned from him. He authored many books, which some of you may have read, but let’s learn a bit more about him.
Dr. Hinohara was born in Yamaguchi Prefecture in 1911, and he moved to Tokyo from Kyoto three months before the start of the war in 1941; since then, he has been working at St. Luke’s International Hospital. He received the Cultural Merit and the Order of Culture and passed away April 18, 2017.
Blood flows fine through a normal blood vessel, but as arteriosclerosis progresses, the wall becomes thickened, and substances such as grease can collect on the wall, thereby narrowing the channel for blood flow. The end result is myocardial infarction or stroke, depending on which blood vessel is clogged.
When such a change occurs, imaging findings show an abnormally bulging or jagged aorta. This indicates weakened walls with swelling; they eventually tear, leading to major bleeding. When the blood vessel weakens, it may become clogged or broken. In blood vessels of the chest, as arteriosclerosis progresses, blood can no longer pass through the clogged vessels, causing pain and the failure of organs.
However, Dr. Hinohara was quite healthy, and even at 100 years of age, his blood vessels in the brain and neck were very smooth and beautiful.
Arteriosclerotic changes in the heart are shown here; this is an 83-year-old woman, and the coronary vessels are very thin and jagged.
This is a view of the blood vessels of the heart obtained when Dr. Hinohara was 98 years old. He had thick and beautiful blood vessels, except that one portion that showed thinning.
Brain changes can also occur. We see here a scan from an MRI examination of the brain of a 90-year-old patient. This white portion indicates a lack of blood.
However, Dr. Hinohara did not have any whitish appearance, even when we inspected him at 98 years old. You can see how the progression of arteriosclerosis was slow compared to that in many others.
As you can see, Dr. Hinohara maintained a relative state of youth even into his golden years. I returned to Tokyo from Kyoto 14 years ago. He had these types of diseases from the time I returned to Tokyo until his death. For example, he had undergone an operation for inguinal hernia twice, but the day after surgery, he delivered a lecture. As soon as he could move, he was discharged and returned to work, saying that he wanted to leave the hospital as soon as possible.
This episode of atrial fibrillation and arrhythmia was very impressive. Dr. Hinohara liked to watch sports on TV, and he was very excited to watch the international match of women's soccer; during this viewing, his blood pressure rose and he temporarily developed arrhythmia. When he visited the hospital, his heart was in arrhythmia, beating very irregularly in a condition known as atrial fibrillation; his condition was resolved immediately following electric shock.
Despite such incidents, he lived a normal life until just six months before his death, at which point the function of various organs in his body gradually declined. He was unable to swallow well, and while he could have extended his life by receiving nutrition from a nasogastric tube, he declined to receive such attentions and died quietly.
I’ll next touch on what he thought was the secret to his longevity. For meals, he had bread and juice in the morning, and he liked olive oil very much; he told us frequently that this was the secret to a long life. To be honest, I do not understand why he thought we can live longer if we buy our own clothes, but it seemed to be connected in Dr. Hinohara's mind. He told us frequently that it is not good to leave everything up to one’s wife. He also said that it is important to measure your body weight, body temperature, and blood pressure by yourself. In addition, he kept a diary in which he was able to schedule appointments up to 10 years in advance, which he had been keeping dutifully. Even at his passing, his diary still showed plans for lectures several years later.
2. What is "healthy aging"
The phrase "healthy aging" has recently been tossed around. We believe that Dr. Hinohara was a prime example of "healthy aging", and I have identified three factors that I feel are associated with healthy aging.
The incidence of diseases gradually increases with age. However, the first element of healthy aging is the absence of any chronic disease that can impair the function of the body. Second, you must be able to enjoy life. Third, you must be able to do what you want without physical, mental, or social limitations. "Healthy aging" thus satisfies all three of these elements.
I would like to briefly discus the cases of death among Japanese. Cancer is the most common cause of death, followed by heart disease. Until the year 2011, the third-most common cause was stroke. The fourth-most common cause is pneumonia, followed by unexpected accident, which includes various accidents, such as traffic accidents. Senility comes in at sixth.
Since 2012, however, pneumonia has been the third-most common cause of death, followed by stroke and then senility. When I graduated from college, I was taught to avoid making a diagnosis of senility whenever possible. It was a shame. This meant that the doctor did not understand what was happening in the patient's body.
Recently however, the frequency at which senility is diagnosed has been increasing. Making a diagnosis of senility no longer reflects poorly on a doctor’s ability. Such a diagnosis is considered preferable for preventing unnecessary examinations, especially in elderly people. Natural death is widely accepted. It is not considered good to clarify the details of health problems until the last moment, as they may cause the patient pain. Ultimately, I am of the opinion that it is a good thing that senility is more frequently diagnosed.
Treatment of cancer is progressing at a fast rate, with new medications targeting immunity, resulting in an increased cure rate among patients who were thought to be in the late stages of their disease. While it may take decades yet, the day may come when no one dies of cancer. If this disease can be eradicated, the lifespan in Japan may extend for another 3 to 4 years at a stretch. If cardiac disease can be eradicated, the lifespan in Japan may be extend by approximately 1.5 years. If stroke can be eradicated, the lifespan may be extend by approximately 1 year. If both of these diseases can be eradicated, it is now thought that the lifespan of women and men can be extended to 93 years and 87 years, respectively.
The lifespan in Japan was about 50 years after the war; these days, the lifespan is 80 years in men and 86-87 in women.
Japan is trying hard to extend the healthy life at present. Although these data are slightly old, the difference between the average life expectancy and the healthy life expectancy equates to a period in which individuals are almost completely bedridden. Men are bedridden for about 9 years and women for about 13 years. Since this means that we may spend as much as 13 years without any form of social activity, shortening this period is the goal of the National Welfare Administration.
The following are considered to be the biggest causes of this bedridden period:
Stroke or heart failure can eliminate your ability to move freely or do anything yourself. Dementia has various degrees of severity, from very mild to the point where an individual cannot move, requiring constant outside care. Fracture is also a very big problem, as the frequency of toppling over and falling increases with age, and many people suffer fractures of the back bones and bones at the base of the foot, which reduces or eliminates their mobility. Depending on their age and condition, it can be very difficult for an elderly person who has been completely bedridden for about three weeks to return to their original social activities afterwards. Finally, chronic obstructive pulmonary disease, which requires an oxygen supply and wheelchair for mobility, is due to cigarettes in almost 100% of cases. This can reduce the lung function and induce chronic obstructive pulmonary disease, wherein the oxygen delivered to the lungs is poorly taken up into the blood.
At present, Japan is trying to address these four causes of a non-healthy life.
Heart failure in particular is a major problem that needs to be resolved. Previously, the greatest problem was myocardial infarction, when blood vessels that support the muscles of the heart become clogged and oxygen and nutrition cease, resulting in muscle death. About 30% of people died due to myocardial infarction in the past. However, deaths due to myocardial infarction have decreased in recent years with improvements in treatment. Instead, the force at which the heart pumps blood will gradually weaken, until the occurrence of heart failure after 10-20 years of myocardial infarction, as a result of the combination of damage after myocardial infarction and the effects of aging. Under such a condition, even the slightest exertion can make one short of breath and feel bad. Daily work becomes very painful over time, so heart failure has become a major problem in developed countries. In Japan as well as in the US, the number of patients with heart failure is on the rise.
One way to prevent such diseases is to avoid becoming sick in the first place. If this fails, the next best option is to identify the disease quickly and prevent it from worsening. Avoiding becoming sick in the first place is called primary prevention, also known as health promotion. Identifying the disease quickly is called secondary prevention and involves identifying and treating your condition at a medical examination when you have no symptoms yet or when symptoms are very slight.
Unfortunately, prevention efforts cannot stop illnesses due to genetic factors, but prevention is possible for a considerable portion of major diseases, such as diabetes, hypertension, aneurysm, cholesterol issues, obesity and cancer.
I would like to omit the contents from here, as I think you have heard about it many times.
I showed here how to correspond to diseases, but this is not easy to practice. Actually, that is the problem. Recently there have been many lectures on how to make people practice. I would like to discuss this.
3. Body health and mind
It is said that stopping smoking can extend the lifespan of people all over the world in a matter of two to three years. If cigarettes were to disappear from the earth completely, fewer people would suffer from heart disease from the very day after cigarettes ran out. This is because the heart becomes more and more damaged with each smoke. Regarding cancer, the effect of quitting on the risk is not realized until 5 to 10 years after quitting. Tobacco is the true culprit of a number of blood vessel diseases as well as cancer. As a person involved in medical care, taking the time to persuade smoking patients to kick the habit as soon as possible is the best way of prolonging their lifespan.
Meals are also very important. Although meals are a daily event, they are significantly associated with health.
The existence of diseases related to animal fat and red meat has been proven. However, it is not recommended to avoid them completely. Dr. Hinohara also only ate small meals; while in the hospital, he only consumed bread and juice and olive oil in the morning and four to five cookies and a pack of milk during lunch. However, he did not say anything about dinner at all. To my surprise, when I asked his family about dinner, it seems that he have been eating steak for three days a week. Given the relatively high value of protein in his blood, we had assumed he’d been consuming it somehow, but he had never mentioned anything about this habit. I think that it is unfair to mention a small appetite without discussing the eating of steak. I would like to complain to Dr. Hinohara about this. People who only hear about a small appetite might consider the intake of protein to be unnecessary. Protein is of course necessary, but eating too much is not good. If you eat hundreds of grams of red meat every day like people in the United States, your cholesterol can increase, which can be quite detrimental to your overall health. Avoiding it altogether is also not good. Everything in moderation!
A continuous stream of papers has been published underscoring the favorable effects of exercise on one’s health and life expectancy. However, here again, everything in moderation.
Exercise can induce various changes in the body. While some people may be able to run a marathon, running such a long distance can induce the production of various chemicals. Running a marathon seems to be painful when you look from the outside, but the person who is running is pleasant because a type of narcotic drug is produced in the body.
Exercise is considered quite nice unless one is injured. Walking fast is a great way of exercising, as one can avoid injury while still reaping the benefits. Current guidelines advise walking 3 times a week for 30 minutes to 1 hour at a time. Exercise has the effect of lowering blood pressure. It is now widely known that this amount of exercise does not achieve the expected amount of body weight reduction, even though it consumes approximately 200 kcal. In the past few years it became clear that this simply happens because the person does not move their body after exercise. Everyone want to rest after exercise. A person’s body weight will not be reduced if their calorie consumption after exercise is lower than normal.
In addition, while various studies have described the preventative effects of exercise against depression and dementia, it is also believed to help prevent cancer as well.
It should be noted, however, that those with heart disease or the like may suffer cardiopulmonary arrest in the midst of a marathon or similar heavy exercise. It is therefore best to be sure you are free of heart disease before starting an exercise when you are over 40 years old. Some people become obsessed with exercise, even though they start unwillingly. There are people who want to run a marathon every week. Too much exercise is not good for your health.
This was a famous study that was performed 40 years ago. In my opinion, it is the best study of its kind. People who stick to these seven activities seem to live longer than those who do not. However, regarding ‘moderate drinking, a recently conducted large-scale global study showed that even a small amount of alcohol is not good for one’s health, although this result needs to be verified by other studies. Data have also suggested that eating between meals and not eating breakfast are related to the mortality rate.
Because such prevention depends on the daily habits and actions of each person, no one else can control it. People cannot do these things unless they truly desire to do so. To adopt a better lifestyle is very difficult and applying external pressure on its own is of little use. This is also obvious. When I took part in an interview for a magazine to talk with the chairman of a pharmaceutical company, the man asked, "What kind of medicine would you like to have in the future?" I responded, "I want a medicine that will make patients listen to what I tell them." On taking this medicine, patients would promptly agree to quit smoking immediately, take their prescribed medications properly, and listen to whatever their doctor says. Such a medicine would be wonderful to have!
It is said that there are six stages to changing your own behavior.
At first, people do not feel like listening about changing their own behavior. For example, let’s consider smoking. The next step is therefore to start thinking about the issue a bit. The doctor will talk more and more, as will the nurse, about whether or not to stop smoking or how much merit is involved with stopping. As such efforts will generate various undesirable issues at the same time, you must then start thinking about all manner of events. You then decide to do it, followed by actually doing it. If this approach works, you can then proceed to the maintenance phase, but in many cases, you will return to the first phase. A good half of those who try to switch to a more desirable lifestyle will return to the first phase. However, you mustn’t get discouraged. It isn’t bad to fail, so just try again. The behavior can be changed by repeating it several times, so I feel it’s fine to repeat this cycle of trying and failing and trying again.
4. Connection with society
Finally, for "healthy aging", forming and fostering a connection with society is very important. A survey found that people who contribute to society have a lower mortality rate than those who do not. Contributing to society itself can be broadly categorized into two aspects: dedicating time (like volunteering) or money (including donations).
Many people feel that it is better to provide time, such as volunteering, and that just giving out money is meaningless. However, a survey study recently revealed a health benefit due to making donations.
The results of the study presented here show that donating money can help reduce your blood pressure. As I found these conclusions dubious, I carefully read the original paper and saw that two types of studies were actually being conducted. In one study, 186 elderly patients with hypertension were monitored, with results showing that the more money they spent on others, the lower their blood pressure. This type of research can be conducted via questionnaire survey. Some subjects donated to other people, such as fellow patients and their country, while others spent money on their friends or family. In either case, the patients were spending the money on anything other than themselves. In the other study, 73 patients were divided into 2 groups of 36 and 37 and given $40 three times a week for a total of 6 weeks; 1 group spent money on themselves (e.g. purchasing clothes), and the other spent money on others (e.g. donations). In the group that spent money on others, both the systolic and diastolic blood pressure dropped by about 5 mmHg. There were no marked changes in the group that used the money for themselves.
This is a very convenient result for those who receive the donation. However, the donation is also beneficial for those who donate. If this result is confirmed by other groups, I think that more Japanese people will adopt the culture of donation. I believe that donating money or your own time is an important element for forming a connection with society. I believe that such research will be carried out more and more in the future.
Today, I discussed the concept of "healthy aging" following the death of Dr. Hinohara at the age of 105. I hope this lecture has been educational. Thank you for your attention.
【Dr. Nobuaki Shikata, director of Izumiotsu City Hospital Laboratory and Pathology Center】
Thank you very much, Dr. Fukui. My wife composed songs for Tamago nursery school, and she was a member of the Music Therapy Society of Dr. Hinohara for a while. I believe that Dr. Hinohara was a doctor with profound knowledge of cultural aspects as well as scientific principles. We heard a story from a very famous teacher today. This was a precious opportunity. If you have any questions, please raise your hand.
【Mr. Seita Tanaka, Mayor of Yao】
Thank you very much for your lecture. Yao city is now targeting the health promotion of its citizens. We have a slogan, "Let’s build everyone's health together." We will issue the “Declaration of healthy city creation” at the beginning of October this year. We will make 5 outlines and practice them with citizens. There are three things I always say to the citizens. "Do some exercise or sports." “Pay attention to what you eat." "Have a connection with society and participate in society." You told us the same thing today. I feel that your discussion supported the theory today. This is my 12th year since I was first elected mayor. There is a thing called the "Leave it to the mayor donation." I received approximately 400 million yen over the past 12 years. Half of this sum was from a senior citizen who had told me that he would leave me 100 million. When he died, I received approximately 200 million yen. This was really a social contribution. I received the donation because he said he wanted to do what he could for society. People who are financially well off tend to be much more comfortable than those with relatively little money. I think that it is more fun to volunteer. What should we do if we do not have money?
【Dr. Tsuguya Fukui, Director of St. Luke's International Hospital】
Volunteering is relevant to health. I told the story at the end because there have been no data to show that donation is relevant to health. There are studies that show that volunteering is relevant to health. The amount of money you donate has nothing to do with the effects on health. I think there is a considerable effect on health, even if you donate a small amount of money.
【Mr. Seita Tanaka, Mayor of Yao】
Yao city has a “my hometown tax”. People also donate to the Red Cross. I have seen children donate 10 to 20 yen from their pocket money. I think that the donation culture may spread in Japan. We also ask for donations to support the city of Yao as well.
【Dr. Kunihiko Ishigaki, the Director of Tamago Building】
Dr. Fukui, thank you for such a wonderful lecture. If the mayor donated the "Leave it to the mayor donation" to the Tamago building, the mayor himself would become more healthy. A more energetic mayor would be helpful to the development of Yao City. That is a wonderful thing. Thank you very much for speaking with us today.
Mayor of Yao