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Searching for the key to a long, healthy life

OHSU endocrinologist offers thoughts on American health and its care system

Dr. Jonathan Purnell is an endocrinologist at Knight Cardiovascular Institute. He exemplifies good lifestyle practices – walking to work, standing at his desk, cooking and eating whole foods at home.

Dr. Jonathan Purnell is an endocrinologist at Knight Cardiovascular Institute. He exemplifies good lifestyle practices – walking to work, standing at his desk, cooking and eating whole foods at home.

Want to live a long, healthy life? Pick your parents … and your zip code.

This “prescription” is offered tongue-in-cheek by Dr. Jonathan Purnell, because he knows both often are beyond our control.

However, he admits that where a person lives can actually determine how well they care for themselves. Having greater access to healthy food, parks, social services and community resources is also important.

Purnell, an endocrinologist and professor at the OHSU School of Medicine, is involved in research at the Knight Cardiovascular Institute, the Bob and Charlie Moore Institute of Nutrition and Wellness, and the Division of Endocrinology, Diabetes and Clinical Nutrition.

He has a healthy curiosity about a variety of healthcare philosophies and has found the broader prospective “illuminating.”

Focusing on the problem

He believes many cultural and socioeconomic factors in this country that determine who lives best and longest “in the real world” are not properly addressed. That includes a focus on obesity, diabetes and heart ailments, all of which are influenced by availability to healthy food and active lifestyles.

Purnell says the answers lie in better urban planning, as well as a focus on healthy pregnancies. He also says the cost for healthcare in the United States is two to three times more expensive than in European countries, and the outcomes are not the same.

“But they spend more on social services than we do, and if you factor that into what they spend, it’s about the same (regarding costs),” he says, adding that the American system of medicine focuses on individual responsibility whereas Europe has a “collective” ethic.

In the United States, there is no reimbursement for many alternative approaches, such as preventative healthcare services. Allopathic physicians are trained to treat disease, but “good health is not dependent on just one thing,” Purnell says. Naturopathic medicine looks at the whole person and focuses on prevention.

However, he says, “If you have a disease, the best medical care in the world is in the United States.”

Purnell is a handsomely attired man who exemplifies good lifestyle practices. He credits “healthy stock,” but also tries to incorporate as much activity into his daily duties as possible – he walks to work, uses public transportation and stands at his desk, among other measures. He and his wife eat at home, cooking with whole foods that include an abundance of fresh fruits and vegetables. “We’re blessed to be in a city in which we can live that creed,” he says.

Health concerns

He believes health concerns among Americans may be triggered by poor endocrine function and autoimmune problems that are essential to living long, active lives. The endocrine system influences almost every function within the body; it is involved in growth, metabolism, mood, tissue function and more. Hormones from the endocrine system control and coordinate activities within the body.

Autoimmune diseases impact up to 50 million Americans, Purnell says, and there are more people with autoimmune diseases than cancer and heart disease combined. There presently is no cure for autoimmune diseases.

However, modern medicine means the symptoms can be addressed effectively and this doctor is optimistic that, from the endocrine standpoint, it is still possible that physicians will get better at replacing hormones that decline with age in such a way that people are healthier and experience fewer side effects.

The thyroid is the cause of many autoimmune problems, and while most physicians check its function, many don’t look at the thyroid as the source of problems. Purnell says it is so complex that disease and the loss or decrease of endocrine function often can be overlooked.

Among the factors that impact the aging process are growth hormones, declining testosterone in men and estrogen in women, and rising cortisol levels.

“These are subtle changes over time and they are responsible for a lot of body chemistry as we age,” Purnell says. “It’s why we lose muscle and gain fat, and our body composition changes.”

Treatments and supplements

With such noted changes in the body, many seek to overcome or balance out those changes with treatments and supplements. Purnell says many of those available at so-called anti-aging clinics and through alternative medicine practitioners can have serious side effects when they replace what the body normally does with medication. The treatments are complex because hormones change from day to day.

Purnell says there is no current recommendation to replace declining hormones and, while some hormones may improve body composition, some have been linked with increased risk of heart attacks and arthritis. Additionally, these therapies often are very expensive.

Complementary research

So, Purnell collaborates with the National College of Naturopathic Medicine through its Healfgott Research Institute to investigate such things as anti-inflammation diets, lifestyle changes that affect wellness and longevity, and even a placebo effect. The complementary research is all food-based.

“I prefer the ‘whole foods’ approach to research instead of the ‘reductivist’ approach, where specific food ingredients are studied in isolation,” he says. “The issue is complex because research doesn’t lend itself to one thing. What foods, what combination of foods, how lifestyle factors in and how cortisol levels and stress impact longevity and health in general, are all part of the investigation.”

The institute’s research also revolves around an orchestrated change in hormone levels and the impact on aging. If a person is taking cortisol supplements and facing surgery, for example, it could pose a danger to the patient, Purnell says.

Men given testosterone to keep muscle mass can risk heart disease. Women who take estrogen replacement have a higher risk of breast cancer, especially if it exists in their family or they have the genes associated with it. He says women should start taking estrogen in their 50s for it to have the greatest impact and that the estrogen patch is the safest method of delivery.

The $64 billion question

The keys to healthy aging are the basics: be active, do resistance and balance training, and eat healthy. Yet why do so many people avoid taking care of themselves?

“Too many people look forward to a life of leisure as they age,” Purnell says. “They envision relaxing on a hammock. But the evidence says that to age well is to resist this ideal and remain active as much as you can.”

He believes views on aging have much to do with a person’s belief system about getting older. “It’s the $64 billion question. How do you convince people to overcome inertia? They believe, ‘I can’t do that. I used to do that but I’m older so now I can’t.’ Even if your muscles ache when you exercised, don’t stop.”

Purnell acknowledges he has great examples for maintaining a healthy lifestyle into the older years. Both of his parents are in their 90s and remain active every day. His father was a mountain climber. His mother learned to jog from Bill Bowerman in the 1960s.

“They adopted whole foods and going to Bob’s Red Mill when it first opened,” he says of his parents. “Living in Oregon, they are blessed with the abundance of outdoor resources and farmers markets.”

Because of his research on obesity, Purnell counsels his patients to eat less and exercise more, but understands that where they live and who “they surround themselves with has a tremendous influence in the choices they make. A (mother) who lives in the country, her husband uses the one car to get to work and there are no sidewalks, is at a disadvantage. In addition, there is a lot of depression in older folks faced with the loss of family and friends.”

He also sees that many older adults are dealing with not only medical conditions, but the side effects of their medications.

“Our healthcare system would benefit from social workers in all communities who would see that people take their medications on a regular basis and not take more than they need,” he says. “We need to create a healthcare system that is embedded in the community and works with the medical community and the environment, including the parks and activities to prevent as well as treat chronic diseases of adulthood, like obesity, diabetes and heart disease.”

In short, Purnell says, the American healthcare system needs to acknowledge the cultural and socioeconomic factors that are barriers to good health practices, and then do something about it.

“Too often we have a problem and we look for one answer and only focus on one thing,” he says. “If it doesn’t have a positive outcome, we abandon the research. We have to recognize that healthcare and well-being are the result of many factors. Science can be fuzzy. Medicine waits for something to happen and then treats it. We need a radical change that switches gears to focus on prevention.”

He would like to see changes in the way physicians are educated, as well as reimbursements for preventative healthcare. And in this regard, “What if the best discussion is not in the doctor’s office, but at the community level? We need to design healthy workplaces, such as stand-up desks that decrease time sitting at computers. Architects need to design inviting staircases, rather than elevators.”

Of note

Dr. Jonathan Purnell’s prescription for longevity: “Live each day as if it is your last, and do not put off what you want to do if you can afford it. Do not worry over what you cannot control. I’ve noticed that the people who thrived while aging, even as their bodies slowly break down and their loved ones pass on, the ones I call ‘survivors,’ have a tremendous capacity to accept what is and has happened to them and move on, working around physical limitations and placing emotional traumas in the past. “One African-American woman in D.C., I remember developed macular degeneration and could no longer drive. She was not depressed or even concerned about it. She just started riding the bus. It’s just what you do and often time opens us to new avenues for experiences and friendships.”

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