Dealing with Common Aches and Pains as We Age with Dr. Donald Ford

Podcast Transcript

Nada Youssef:    Hi, thank you for joining us. I'm your host, Nada Youssef. Today we're keeping you, the men in our lives, in mind as we discuss today's topic, as well as the rest of the month. Today we are taking your live questions about your common aches and pains, because men, you'd do anything for your loved ones, but what about you? When you have a health concern, don't keep it to yourself. Joining us today to talk about your aches and pains is board-certified Cleveland Clinic family physician, Dr. Donald Ford. Thank you so much for being here today.

Donald Ford:      Thank you, Nada. It's a pleasure to be here.

Nada Youssef:    Thank you. And if you just want to introduce yourself to our viewers.

Donald Ford:      Sure. Good to see everybody today. My name is Donald Ford. I'm a family physician. I've been with the clinic. I'm now actually in my 20th year at Cleveland Clinic, and I've worked in a number of different parts of the organization. I do practice family medicine, so I see kids, I see elderly people, women, and a lot of a generally healthy males, and-

Nada Youssef:    I wanted to start kind of talking about starting in their thirties or so, a lot of men start complaining of aches and pains. Can you talk about exactly what happens to the tendons and ligaments in the men's body as he ages?

Donald Ford:      Sure. So, this is probably not a secret to any of us who are kind of getting into middle age and experiencing this kind of thing, especially if we do ... we've grown up very active and maybe have been involved in sports a lot, a lot of times as we're getting into our middle ages, things don't seem to be quite as flexible as they used to be. Now, that's a general statement that you can make about aging in general. Really just about everything about us becomes a little less flexible. Our bones are less flexible, which means they're more brittle. That really only shows up as we get quite a bit older, but our muscles also get a little bit tighter. As you said, the tendons and ligaments, they tend to not to want to stretch as much. And the thing that I think is the most important of all of these is that our brains get a little bit less flexible too. So that's where we have to be really careful and really work to try to maintain our flexibility.

But it doesn't mean that we're destined to become shrunken robots. It means that we have to work harder to get the same thing. So you really have to dedicate yourself to exercise, and particularly stretching. So anything that you do physically that involves stretching the whole body, it's great to lift weights, it's great to build your muscles, but what's really important is how flexible you keep yourself. The more you do that and the more consistently you do that, the fewer problems you're going to have in terms of aches and pains as you get older.

Nada Youssef:    Do you recommend like daily, morning, night? What do you recommend for stretching?

Donald Ford:      Well, there, there are a few different exercise recommendations. So in terms of cardiovascular health, the general recommendation is to try to do at least 30 minutes, five times a week, but I will tell you, you're absolutely right. In terms of the stretching, it's much more important to do it as consistently as possible. So even if you do 10 or 15 minutes of concentrated stretching when you wake up in the morning or before you go to bed at night, you're going to do better in the long run and you're going to feel better.

Nada Youssef:    Great. Now you mentioned the brain, flexibility in the brain. Can you go into that a little bit more?

Donald Ford:      Sure. Yeah. So it's actually just a physiologic process that we see that we tend to grow fewer dendrites, which are the communicating part of the neurons in the brain, the brain cells, and we also tend to have lost some of our ... the type of material that's in the brain called the Schwann cells that insulate the, electronic impulses that go through that create thoughts, that create memories, that create imagination. So it's very hard to measure on an individual basis, but we can see it across the population. So it's harder to make new memories. It's harder to make connections and to hold a lot of things in your brain at once.

There's what we call age-related cognitive changes, and those are what we consider normal as you go through life. It is very distinctly different from anything like Alzheimer's or other forms of dementia where there's a rapid decline, a predictable course. Age-related changes are true, and it's the same thing I just said about the physical body. It doesn't mean you're going to end up not being able to hold thoughts or remember your kid's names or anything like that. You just have to take that into account. Slow down a little bit.

All of us, even myself in my 50s, I'm trying to do a hundred things at once. I got my phone and I've got ... I'm seeing patients, and I'm trying to talk to my family and my kids and everything. As we get older, we have to be able to sort of concentrate a little bit more, and that helps counter the effects of aging on the brain. So it's not so much that I'm looking for a magic cure. It's that I have to change my own behavior in order to compensate for what happens as I get older.

Nada Youssef:    And that also includes diet, what you're eating, it includes exercise-

Donald Ford:      Absolutely. Yup.

Nada Youssef:    ... meditation, whatever it is, right?

Donald Ford:      Yeah. We talked a bit about exercise, and I'm happy to talk more if anybody has any questions about that. Diet is very important. I am a believer in a balanced diet. I don't think there's been any hard evidence that going vegan or vegetarian is necessarily a better thing in terms of living a longer life, but within having said what I just said, we know that you got to watch foods with high cholesterol, red meats and so forth. You really have to limit them if not eliminate them from your diet. A plant-based diet is extremely healthy, but you can also overeat on a plant-based diet. So it really is a question of eating the right amount for your body so that you're able to burn the same number of calories you're taking in, make sure you're getting plenty of vitamins. Everything that we talk about in terms of possible supplements, calcium and vitamin D, all the other things that there's tons and tons of press about.

The best way for the body to absorb all of these nutrients is through food. You absorb much more. You absorb it at a much more natural pace so your body can actually use it and doesn't just end up urinating it out or getting rid of it because you've given it too much.

Nada Youssef:    I see. So the nutrients would be actually absorbed in the body and being used.

Donald Ford:      Absolutely.

Nada Youssef:    I see.

Donald Ford:      And so even when we're talking about something like osteoporosis and we talk about calcium and vitamin D, my advice to patients is get your calcium through your diet. Now, if you don't eat dairy products, and I know we can talk about some of the problems related with people eating dairy, there are actually better sources of calcium that are nondairy. Leafy green vegetables, your kales, your leafy greens, many other vegetables are much better sources of calcium, even than dairy product.

Nada Youssef:    That's amazing. That's great. Thank you. Well, I want to kind of go back to some of the aches and pains that we're talking about. So a lot of men are the ones taking care of the housework, the yard work, and a lot more than often you hear my back gave out on me. What does that mean? What actually happens?

Donald Ford:      Well, there are a lot of things that can happen with the back. We tend to make ourselves a little bit vulnerable in terms of our back. I won't stand up to demonstrate this, but I could, but one of the things that happens to men's bodies as we age, we tend to carry our weight in the front. It's what's commonly called a beer belly.

Now, I don't drink, I don't drink beer, but I get a beer belly because that's where it just genetically, as a male, that's where my weight tends go. And what that tends to do is it tends to sway you forward, so it's actually putting a new type of pressure on the lower back. So unless you're really working to compensate that, A, keep the weight off, B, keep the back nice and strong and healthy, there's a tendency for the back to be pulled forward. And so what that does is it puts pressure on the posterior parts of the spinal cord, so anything that strains the muscles back there is going to cause extra damage. We're just more at risk as we age, if we're not paying attention to those kinds of things.

Nada Youssef:    Sure. And also, men are more at risk of injuries taking longer to heal as they get older.

Donald Ford:      That's true.

Nada Youssef:    Can we talk about that as well?

Donald Ford:      Yeah. So that, again, it's part of the general aging process that I was talking about, and there are changes in the immune system as we get older. There are changes in terms of our blood cells. So overall, healing is going to take longer. One of the things that happens with our soft tissues, ligaments, tendons, muscles, over years we tend to deposit calcium into those soft tissues, and that's part of what makes them a little less flexible. You can actually look at X-rays sometimes and see calcium deposits in some of the ligaments, and if you get a lot of that, it's going to be very hard to stretch and pull those. There are other places that we deposit calcium in our body. People know about calcium scoring for the heart. We thought at first it might be a great way to predict cardiovascular disease. We use it actually more now as sort of a confirmatory test, but it's still the same phenomenon that as we get older, our soft-

No. Sleep quality doesn't decline, but the thing you have to realize, and again, this is a way that people can sort of forewarn and forearm themselves, our need for sleep changes. As we get older, we need less sleep.

Nada Youssef:    We do?

Donald Ford:      We do. That is true, but-

Nada Youssef:    Okay. I thought it was a myth.

Donald Ford:      ... but we need it in smaller doses too. So a person who's getting older may not actually need to sleep the same eight hours that we did when we were 20 or when we were 30. They may get better ... feel okay on six, but they may really conk out in the middle of the day, and it's funny how that works out. As people are sort of approaching retirement, there's actually an opportunity there. Hard for us that are still working, but-

Nada Youssef:    The rest can nap.

Donald Ford:      Yeah. You could still figure things out.

Nada Youssef:    Sure.

Donald Ford:      So it actually is natural for an older person to sleep less at night, but also to need a nap during the day so that they can kind of compensate for that. Our bodies are very active when we're sleeping. It's one of the big mysteries in terms of how our bodies function, but really, we're just as active when we sleep as when we're awake, it's just that it's all internal and it's all maintenance work and it's all repair work. So that's when all the healing happens.

Nada Youssef:    So then the quality of sleep could still be effective, it just may be shorter.

Donald Ford:      Oh, absolutely. Yeah. Yeah. And you have to realize that, and I think ... I see some of my older patients who were very frustrated because they really don't sleep as much at night and then they feel tired all day, and it's just what I was talking about. Well, you don't need as much at night, but you do need it in-

Nada Youssef:    It's just like pockets throughout the day. I see. Okay.

Donald Ford:      ... a couple of ... Yeah. In a couple of sessions.

Nada Youssef:    Right. How about weight, and it becomes harder to lose weight?

Donald Ford:      Yup. It becomes harder to lose weight. You said it perfectly. It doesn't become impossible to lose weight. It just becomes harder. Why is that? Because we burn fewer calories. So when you're 20, you just sit there, you're burning calories. Somebody is going to invent a camera where you can just see them steaming off the top of their head. But as we get older, even though we still have an active metabolism, even though we're still digesting and everything I said about how we're still working on ourselves when we're sleeping, overall you have a lower caloric need. You need less energy to do the same thing that you're used to doing. And so you can eat the same as when you were 30 and put on weight.

Nada Youssef:    And gain more weight.

Donald Ford:      Yeah. People are really frustrated by that sometimes, and they say just quite literally that. They say, "Dr. Ford, I'm eating no different than I used to," and I say, "Well, but your body's changed, so your calorie requirement has changed as well." So you can exercise and burn more calories, you could take in fewer calories, but you have to be able to compensate like that and find your own balance because there's no machine I can plug you into that's going to tell me exactly the number that you need at any given moment.

Nada Youssef:    And no two people are the same.

Donald Ford:      And no two people are the same.

Nada Youssef:    Okay. So you said metabolism could still ... I mean, isn't the metabolism kind of shot through the roof when you're older, or is the metabolism still something that you can maintain a good metabolism?

Donald Ford:      Oh, yeah.

Nada Youssef:    As we age, I thought it maybe is affected with age.

Donald Ford:      Yeah. Well, metabolism I'm using it in the general sense of just the process that our body's take in energy, use it to do functions, move, maintain our organs, pump our heart, doing all those things, and then we eliminate what we don't need. That's the very general sense of the word metabolism as I see it. So no, we continue to metabolize. It's just that, again, in terms of the number of calories that you have to take in to maintain your body, it's fewer when you're older than when you're younger.

Nada Youssef:    Okay. Okay. Now, speaking of digestive, a lot of people end up ... They were not lactose intolerant. They were drinking milk and eating cheese, and then all of a sudden they get older and everything has changed.

Donald Ford:      Yeah.

Nada Youssef:    What happens to your body? How does that happen?

Donald Ford:      Well, it turns out that it kind of makes some sense if you think about it. There's only one point in our lives when we actually need to digest milk in a natural world. If you think of sort of a caveman or, you know-

Nada Youssef:    Baby?

Donald Ford:      Yeah, when we're a baby, right? So that's the only source of food when you're a baby, is milk, so you need to be able to digest the sugars that are in milk. Lactose is the main sugar that's in milk. As we get older, again, sort of from a natural perspective, if you think about what we were like before there was civilization, you got to be a teenager or in your 20s, you didn't need to digest milk anymore. No one was eating or drinking milk or dairy products. So we're left with this kind of a grandfathered genetic code that says, "Well, you don't need so much of that enzyme as you get older," so most people become lactose intolerant as they get older. It's something on the order of 67%, if I remember the statistics, will end up being lactose intolerant of some degree or another.

Now, the funny thing is that it can really range in terms of how severe it is. So you've got younger people who get really ill if they take in anything, if they have a pizza, if they drink a glass of milk, and then other people as they get older, they get into my age or older, and then all of a sudden notice that they get a little rumbly in their stomach anytime they have some dairy products. So it can be a big range of symptoms, but you should recognize that, and it's really important as you're getting older, if you do notice that in your response to your diet, it's the easiest thing in the world. Just eliminate the dairy products and see how you do.

Nada Youssef:    Yeah. Okay, great. Okay, so I want to talk about joint pain and what causes it, because I've read quite a bit about overuse and under use. So, yeah, let's talk about that a little bit.

Donald Ford:      Well, the answer is yes. It's both of those.

Nada Youssef:    It's both of them.

Donald Ford:      Absolutely. Yeah. Yeah. Overuse, so as our tissues are getting a little bit stiffer, the cartilage, there's less moisture in it so there tends to be a thinner layer of cartilage, and you can actually see on X-rays sometimes how, as people are getting older and they've used their joints quite a bit, you can actually see those bones starting to get closer and closer together. So long-term overuse absolutely causes problems. We see a lot of overuse injuries that have to do with the upper extremities, so a lot of wrist things. A lot of people do things at work where they're having to do the same-

Nada Youssef:    Motion. Yeah.

Donald Ford:      ... movement over and over. One of the things that happens is it just doesn't give parts of our body a chance to rest. And I said ... I was going to say wrist because I was thinking about carpal tunnel syndrome. So a lot of people who sit at keyboards, things like that, actually puts a lot of strain on the wrists and causes inflammation. Carpal tunnel is a problem where there's actually a literal tunnel. If you were to take a cross view of the wrist and you look down this way, you'd see that there's a little tiny tunnel right there where something called the median nerve goes through. Now, that's a tunnel made out of bone, and it's wrapped on the inside with soft tissue. So when that soft tissue gets inflamed, it starts to press on the nerve, and that causes all the symptoms of carpal tunnel, which can be a little bit of numbness or tingling-

Nada Youssef:    Right.

Donald Ford:      ... and then you shake your hands out and you feel better, to actually starting to notice that the hands are becoming less mobile, and you'll even see shrinkage in the muscles around the hands. It could be mild or it could be severe or anything in between, but that's a good example of an overuse injury.

Under use is ... Well, we can say this in general about every type of activity. As you get older, life becomes about use it or lose it. So if you're just sitting around, the more you sit around, the more you sit around. If you're on a couch, your body isn't getting any of the activity, it doesn't get the blood flow, it doesn't get the lubrication in the joints that it needs. And plus, you're going to be burning less calories. You're going to tend to put more weight on. So keeping up a good level of activity throughout the day, even when we talk about 30 minutes of cardio and 15 minutes of stretching and so forth. What's really important is to be active through the whole day through your whole life.

Nada Youssef:    Good. Oh, and I was going to ask you about some home remedies, but I mean, first thing, definitely exercise and balance, stretching.

Donald Ford:      Yup, absolutely.

Nada Youssef:    But are there any home remedies that you can think of for the men listening or watching?

Donald Ford:      Sure. Home remedies would be like so if they are having problems raking their leaves in their yard, they can come over to my house and rake my leaves and see if that feels any better to them, right?

Nada Youssef:    We'll make sure your number is at the end of the screen.

Donald Ford:      Okay? All right. All right. Just text me and I'll give you my address. Right? The things that we talk about, really, it's all about lifestyle. So it doesn't matter where you live, it doesn't matter what kind of job you have, it doesn't matter, all these, whether you're rich or poor ... the ability to live a healthy lifestyle. There are sometimes that it's definitely harder, and this is one of the issues that I care about quite a bit is to make sure that people throughout our society are able to get good, healthy foods because there are absolutely areas in the inner city, and even in the country, ironically, where you can't find good fresh vegetables, and that's so important to living a healthy lifestyle.

So putting aside from a couple of things like that, everybody's got the ability to exercise. Everybody can eat at least calorie-wise a sensible diet, and everybody can stay active throughout their life.

Nada Youssef:    All right, I'm going to start with the live questions because we're getting many.

Donald Ford:      Please do. Yeah.

Nada Youssef:    So first I have Todd, what can be done about chronic pain?

Donald Ford:      Okay, great question, Todd. Chronic pain is really tough. There are all sorts of solutions, and we see a lot of it. I see a lot of it in my practice, and it's not something that's necessarily even just restricted to older people. I see a lot of younger people who have developed chronic pain conditions. It's a big topic, so I'm not sure I'm going to be able to address everything. As a medical provider, I start with everything I just talked about. I start with talking about a healthy lifestyle. And if you look at recommendations from the musculoskeletal societies and from rheumatologic societies, that is number one treatment, and I think sometimes we overlook that because everybody goes, "Oh, yeah. Well, yeah, live a healthy lifestyle, but then what else can you do?" But we have to remember that that, and same thing is true with something like diabetes, it is the best treatment.

Nada Youssef:    No magic pill.

Donald Ford:      Most back pain is going to go away by itself if you just work through it. A lot of musculoskeletal injuries, as long as there's not a tear or a fracture, those are going to go away by themselves. So we can't forget the simple stuff. Now, we have tons and tons of ways of addressing chronic pain. We have medications. So as long as you got healthy kidneys, you can take anti-inflammatory medications. There are some other medications that we use for some chronic nerve problems, something like Neurontin or there's a cousin called Lyrica. Those are problematic medications because they have a lot of side effects, and so we always have to make sure that we're having a good conversation with our patients about the risks and benefits of medications. Even anti-inflammatories like Motrin or Advil are things that can damage your kidneys in the long run if you take too much of them and you're not being careful.

We have lots of chronic pain programs here at the Cleveland Clinic, and we even have kind of an inpatient program that's held over the course of four weeks where people really work, sunrise to sunset for seven days a week, working on really reversing some of the habits and some of the trends that have gotten them into chronic pain in the first place.

So I don't know if I've answered the whole question, Todd, because it's a big subject, but there are a lot of tools that we have. I think everybody's aware of the opioid crisis and how we've really gotten in trouble with this. I am very, very sensitive to prescribing narcotic medications, and there's one general truism that we have to be aware of, which is that the real problem with opioids for chronic pain is that in the long run, not in the short run, but in the long run, they can actually train the brain to perceive more pain. So we're actually creating the same symptom that we're trying to treat. So that is really the reason that we do everything that we can to try to avoid treating chronic pain with narcotic medications.

Nada Youssef:    All right, and then I have Janet. Is male osteoporosis common?

Donald Ford:      Male osteoporosis is more common than we think. That's a great question. We actually have a standard recommendation for every woman who's over 65 to get a bone density test, and there is a difference between men and women in terms of the risk for osteoporosis, and that has to do with the fact that women go through menopause where they lose the production of estrogen or where it goes down, and it's that estrogen that has been actually maintaining the density of the bones for their younger life. So we'll see, in general, we'll see women decline in their bone density much quicker around that age than men do.

That being said, we do have to look very carefully at men, and we have to look at things like ... Everybody's got a relative who used to be 6'4" and now he's 5'8". That's somebody that I'd want to check a bone density test on. There are all sorts of metabolic problems that could be associated with bone loss in men. And again, you know, you got to look at the diet.

Nada Youssef:    Great. And then Ryan, as a 30-year-old male who's trying to restart his metabolism and boost fat burning to lose weight fast, but safely, can you suggest ideas?

Donald Ford:      Well, I'm not sure there's any real secret trick to this, Ryan. The most important thing is that you get the exercise. I'm not even sure I'd love to talk to you because I'm not even sure what you mean by restarting your metabolism or boost fat burning. I guess we all tend to want to get there quicker. There are a lot of things, there are a lot of products out there that say fat burners and they'll build nothing but protein and all this stuff. I'll be completely honest and say I get worried about some of those products. A, you never know what's actually in the bottle or what's in the pill, and B, even if it's something that is purely thought to be safe like protein, the creatine that they sell, I've seen a number of young men, men your age, coming into my office with elevated kidney tests because they've been doing these supplements that are supposed to build muscles and help them burn fat and so forth.

Nada Youssef:    Most of these are not FDA approved, right?

Donald Ford:      No. Any type of supplement is not under the guidance of the FDA, and this is something that I am always reminding patients. I have a big talk with patients sometimes about ... There's a product called red yeast rice. This is not on men's health but on a separate topic, but that is literally a yeast, a mold that grows on rotting rice that they put in pill form. Now, here's the funny thing. It actually works. It's a drug. It's a natural form of a drug that is actually very much chemically like some of the drugs that we use, who's prescribed for getting people's cholesterol down. So I'm not surprised if somebody comes in and goes, "Yeah, it brought my levels way down."

My question is, what exactly are you putting in your body, and how much of it are you putting in your body, and where was it before it was in that bottle that you just picked up off the shelf? I like to give people the image of some rotting rice factory in the Orient somewhere. Think twice about that.

Nada Youssef:    It's a good point though, because to think of what is in it, you don't ... You have no idea.

Donald Ford:      There is no regulation, there is no restriction in terms of the company having to prove that what they say is in the bottle is in the bottle.

Nada Youssef:    Yeah. Get your vitamins, your minerals, everything from your food, right?

Donald Ford:      Yeah, there you go.

Nada Youssef:    There you go. All right, and then I have Sandy. I'll do one more question because time's almost up.

Donald Ford:      Wow. Raced by.

Nada Youssef:    I know. Sandy says, "My husband is on Nexium and complains all the time about his joints and stiffness. Is there anything we can do for his stiffness and joints besides stretching? He claims it's the Nexium, but he can't live without it. He has Barrett's esophagus. What foods are good to avoid inflammation in the body?"

Donald Ford:      Yeah, that's a very good question. It's sort of a complex situation. Barrett's esophagus is a potentially serious condition. It is generally treatable, and we usually treat it with drugs like Nexium. I am not very familiar with ... And I have a lot of patients who have been on Nexium or similar products. I have not seen a lot of folks complaining of specifically about joint stiffness from that type of medication. I'm not saying it can't happen, and it's probably listed. If you look at the disclosure from the pharmacy, it's probably on there, but I'm just saying I have not seen a lot of patients with that particular complaint.

There's not a great thing that I can recommend in terms of a product for you. There's a medication or a supplement that a lot of people are familiar with, glucosamine chondroitin. Now, there is an example of one that actually has had some very, very positive benefits in some of the clinical trials that have been done, but it's been inconsistent. There are a lot of thoughts about that, one of which is the point I just made, which is that you never quite know exactly how much you're getting in terms of that. That's more been in terms of cartilage, so I'm not 100% sure if that's the kind of problem your husband is having. The recommendation I make to patients in terms of that particular supplement is try it and see if it makes a difference. If it does, it may be perfectly fine. If it doesn't make a discernible result, benefit that you can feel, it's probably not doing anything for you.

The last one I would mention too is magnesium because a lot of the stiffness is actually muscular and not so much the joints, and magnesium is a good natural muscle relaxer.

Nada Youssef:    Now, Sandy is asking at the end here what food are good to avoid inflammation in the body. So you're saying like magnesium in food then, to just do that, or what do you recommend?

Donald Ford:      So the types of foods that are generally thought of in the so-called anti-inflammatory diet, it really is going to be the fresh fruits and vegetables. I don't know, again, that there's any medical proof, any scientific proof that raw is better than cooked. We know that cooking can lose a lot of the vitamins and so forth, so, but there are different techniques for cooking. You steam.

Nada Youssef:    And different vegetables are different.

Donald Ford:      Exactly. So my general answer to your good question is a diet that's high in fresh fruits and vegetables is going to be the best anti-inflammatory diet you can have.

Nada Youssef:    Well, we are out of time. Is there anything else you want to tell our viewers before I let you go that we have not talked about?

Donald Ford:      No, I just appreciate everybody tuning in, and it's great to have an opportunity to talk about this topic, and I appreciate the time.

Nada Youssef:    Thank you, and thank you for being here.

Donald Ford:      No problem.

Nada Youssef:    Thank you to our viewers and listeners for listening. For more information for men in your life, to keep them healthy, you can find articles or even events happening in the Cleveland area. Thank you, and we'll see you again next time.