AGEING

As we age, our cells become less functional, and bodily tissues lose the ability to replenish and regenerate. The spine is not excluded from this process and undergoes predictable degeneration as we age. For some, spinal degeneration turns into serious pain and disability that can end in the need for surgery. For others, this is not the case, and they continue to have active lifestyles despite degeneration in the back and neck. What separates these groups? What can we do to make sure our backs work for us as opposed to having to work for our backs (going to the doctors, getting treatments and surgery)? While the answers to these questions remain somewhat unknown, there are many non-surgical interventions to not only extend the life span of our spines, but also of our lives. These include practices such as following a healthy, low-calorie diet, not smoking, treating osteoporosis, and practising a balanced exercise regimen.

Getting older is inevitable. The turn of the century Italian philosopher Giacomo Leopardi had this to say about ageing: “Old age is the supreme evil because it deprives us of all pleasures, leaving us only the appetite for them, and it brings with it all sufferings. Nevertheless, we fear death, and we desire old age.” We all want to continue living, but the price for continued life is getting older, including an ageing skeleton. Unfortunately, aches and pains are going to be in everyone’s future, but as a physician, I have noticed that there seems to be a trick to ageing gracefully. Looking at colleagues and patients, I have seen those who “cruise” into old age and those who “bruise” into old age. In other words, some have no issues in old age, and others have endless problems. While genetics likely plays a crucial role in ageing, we cannot control our genes (yet). However, we do have the power to change environmental factors and lifestyle choices that accelerate ageing. In medicine, we talk about a patient’s genotype and phenotype. The genotype simply refers to the type of genes a person has (for example, a person has a gene for brown hair), while the phenotype refers to the actual expression of those genes (that is, a person has brown hair). Our environment plays a role in determining the phenotype as expressed with this equation:

Phenotype = Genotype + (diet and lifestyle).

The phenotype we all want is one that allows us to live a long, healthy life. We must assume we are stuck with our genotype, but this equation begs the question: what are the things we can do to age gracefully?