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On getting older…

This is a rant I had contemplated writing for some time. In particular, the change in body composition that results in the features we recognise as we age.

The young baby is a creation that inspires awe; amazing elasticity conferred upon the emerging neonate as it traverses the birth canal. Soft pliable skin and joints that can assume amazing positions, courtesy of a group of connective tissues called elastins. Differing tissues have differing elastin composition; arteries, for example, are highly elastic with high elastin content, whereas bone is much less so, and yet, the bones in young children can ‘buckle’ under load (what used to be called a greenstick fracture) as young bones have enough elastin to confer this property, whereas my near 60 year old bones under similar load, with near zero elastin, will shatter, much to my chagrin.

And it’s not just in bones and arteries that we detect the decline in elastic content as we age. The most visible organ is the skin. The appearance of wrinkling, and the progression of skin laxity is a stark visual example of declining tissue elastin content. It has been demonstrated by researchers that the regenerative capacity of our progenitor tissues to replace elastin in tissues is 1,000 times less at age 40 than it was at birth.1 . Ever wondered why smokers, and those who imbibe alcohol, appear to age quicker than non-drinking, non-smoking counterparts? The classic cat’s bum orifice of the long-term smoker, the coarse facial appearance (facies) of the hard-core tippler. Surprise, surprise, the chemical components found in these intoxicants further impair one’s ability to synthesize this group of connective tissue components 2, accelerating the appearance of aging. The characteristic facies of the seasoned drinker or smoker – features the health practitioner is attuned to – reflect the impact of these substances on the composition of the imbiber’s connective tissues.

I vividly remember watching the angst of Nathan Buckley as he tore his recalcitrant hamstring for the last time, prompting his retirement at age 35. Despite his phenomenal physique, his connective tissue-elastic composition had declined to the point that, rather than absorb the mechanical stresses of competition, his tissues tore, and tore, and tore. I am uncertain whether Buckley was a smoker or a drinker, but one has to wonder about the impact imbibing such substances has on our athletes’ longevity in their chosen fields, especially with our drinking culture.

In sports where flexibility is highly valued – gymnastics and ballet come to mind – youth is a great asset, and veterans are coming to the end of their careers from their mid-twenties, unable to compete with younger counterparts, and suffering the impact of recurrent injuries.

No bodily organ or system is immune from the impact of declining elastin content.

Chest wall structures lose their capacity to stretch to ventilate our lungs, which also lose their elastic recoil to effectively exhaust inhaled gases. This results in declining lung capacity, which impacts the oxygenation of our blood, especially noticeable with deterioration in performance with strenuous activities as we age.

With age, the heart demonstrates declining capacity to dilate and increase stroke volume and cardiac output with high demands such as exercise resulting in declining capacity for exertion.

The brain suffers increased susceptibility to the effects of trauma with higher risks of intracranial haemorrhage and brain injury as the brain’s supportive tissues become more rigid and inflexible with age.

The penis…I really don’t think I need to go into what happens as the elasticity of the penile tissues decline. And the vagina…ditto

A great deal of research is going on in the area of connective tissue composition with aging, and how we may maintain our elastin composition despite aging. The magic bullet has so far eluded us (despite the claims of a great many glossy brochures and websites adorned with glowing, smiling, wholesome- looking individuals, selling the usual snake oil). What has been demonstrated is what one might expect:

  • Regular physical activity that promotes connective tissue stretching, without excessive trauma to the connective tissues (which promotes fibrous tissue repair with inelastic scar formation), seems to be one of the more effective measures to maintain elastin composition. Examples include walking, Tai Chi, yoga, Pilates, and swimming.
  • Avoidance of chemical intake that adversely impacts on connective tissue composition (you guessed it, tobacco and alcohol cop it in the ear again, though this is also not an exhaustive list).

Whilst healthy lifestyle does not always guarantee longevity, quality of life would seem to be promoted  by the simple measures mentioned above. And, is it not the case, that quality, rather than quantity, is what most of us would consider the most important aspect of our – albeit too brief – occupation of the orb.

Dr. Alan Underwood

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