It isn’t just the aesthetics of aging that make every decade a little more challenging; it’s the niggling aches and pains. When it comes to issues like heartburn, hair loss and arthritis, symptoms can start to rear their ugly head in midlife, making you wonder what awaits you on the other side of middle age! Fortunately there are some things we can do to mitigate the discomforts of middle age and beyond.

joint pain
If you’re somewhere in the 55-year-old range, this won’t come as a surprise: Arthritis is rampant. Whether it’s from an injury earlier in life or from parents who you may recall complaining about joint pain in the knees, hips, hands or some other spot, most people will experience this symptom of age eventually.

it’s everywhere
Arthritis affects about 50 million adults and 300,000 children in the country, according to the Arthritis Foundation. “It’s very common but is not well understood,” the foundation notes. That could be because arthritis is not a single disease, but rather an umbrella term for joint pain and joint disease. There are more than 100 different types of arthritis and related conditions.

The most common is osteoarthritis, which occurs when the joint cartilage, which cushions bone ends, wears out. Bone rubs against bone, causing pain, swelling and stiffness. Inflammatory arthritis is another common form that occurs when the body’s inflammation process, meant to fight infection, goes overboard and injures joint tissue.

Research suggests that inflammation may play a larger role in arthritis than previously believed, says Dr. David Crane, a regenerative orthopedic specialist at Blue Tail Medical Group in Chesterfield. “Look at other inflammatory diseases—hypertension, diabetes, heart disease. They all seem to be increasing,” Crane says. “Highly glycemic foods, basically sugar and refined carbohydrates, can lead to excessive inflammation.”

you are what you eat
“We used to talk about arthritis as just a loss of cartilage in the joints,” Crane says. “We know that is not necessarily the case anymore. We now know that the synovial fluid that provides lubrication and nutrition to the cartilage becomes injured or damaged probably five or 10 years before the cartilage wears out.”

risks & rewards
“There seems to be a 20 percent familial risk for getting arthritis,” Crane says. “But something usually needs to activate the genes that create the condition. We certainly think about excessive wear and tear on the joints. Injuries in a joint will create arthritis.”

In a perverse twist of fate, joints that aren’t exercised enough also are prone to arthritis, he says. “There is a fine line between too much and too little use. In people who move too little, we know that will progress to joint inflammation, stiffness and arthritis. I tell patients that arthritis likes to move. The studies are pretty clear that you only need 22 minutes a day of moderate movement.”

Cartilage destruction is not inevitable. “Our joints are not necessarily supposed to wear out. Your joint turns over its cartilage every two years. If you’re not repairing it, you’re degenerating.” Environmental pollutants may be driving increases in many diseases, Crane says. “People talk about plastics and pesticides and chemicals—all of those can drive inflammation. Arthritis is a multifactorial and multivariate problem.”

Research has shown benefits in some nutritional supplements. “Some studies show promise with glucosamine chondroitin,” Crane says. About 60 percent of patients encounter relief from joint pain with it. “We tell patients they have to take it for three months and then stop to see if the pain escalates. Also, fish oil and vitamin D can be helpful in driving down inflammation of the joint fluid.”

The late comedian Rodney Dangerfield scoffed at fad diets and exercise regimens, quipping, If I take very good care of myself, someday I will get old and sick. Unfortunately, the same is true of heartburn: You can eat healthy foods and avoid behaviors that cause indigestion yet still be plagued by the
annoyingly uncomfortable ailment.

aptly named
Heartburn is one of those things that happen to the human body rather randomly. More than 60 million Americans experience it at least once a month, and more than 15 million suffer symptoms daily, according to the American College of Gastroenterology.

“Heartburn is that burning in the middle of the chest that usually is related to acid reflux,” says Dr. Christine Hachem, a SLUCare gastroenterologist at SSM Health Saint Louis University Hospital. “It can happen to anybody at any age, and it can mimic the symptoms of a heart attack.”

For women, heartburn may appear for the first time during pregnancy, says Dr. Leonard Weinstock of Specialists in Gastroenterology in Chesterfield. “Any person from teens up can experience intermittent relaxation in the lower sphincter muscle of the esophagus, which is the major cause for acid reflux.” Another is hiatal hernia, in which part of the stomach pushes up through the diaphram muscle, he notes.

The esophagus, a muscular, 8-inch tube, controls the intersection of the throat, airway and stomach. It stretches from the base of the neck to the middle of the chest, where it passes behind the heart. Its upper sphincter (a ring of muscle) separates air for breathing and food for swallowing. The lower sphincter meets the stomach, where it passes food and prevents acid and other stomach contents from traveling backward, or refluxing.

Our stomach acid, or gastric juice, is said to be as strong as automobile battery acid—good for digesting food in the stomach, but not good for the lining of the esophagus.

why me?
“Many women experience reflux during pregnancy because of hormonal changes that affect the lower sphincter muscle,” Weinstock says. “Anyone can have a nerve disorder that allows the sphincter to relax too often at unpredictable times.”

While men and women face similar risks for acid reflux, the odds may shift toward men in later years because they are more likely to suffer a hiatal hernia of the diaphragm—the muscle that separates the chest and abdominal cavities.

“The esophagus and stomach meet at the diaphragm. Normally the ring of the diaphragm causes a cinching of the lower end of the esophagus. It helps to prevent stomach contents from coming up,” Weinstock says. “Possibly because men do more heavy lifting and pushing, they may have more hernias.”

Even without one of these propensities, anyone can be visited by heartburn. “There are many foods that relax the sphincter and worsen the situation,” Weinstock notes. “A normal sphincter muscle can be attacked by four foods in particular—caffeine, peppermint, onions and garlic.”

Additionally, having too much fat in a meal slows stomach activity so the stomach stays full—also not good. “If acid doesn’t move out of the stomach quickly enough, it just sits there and has a chance of coming back up,” Hachem says.

now what?
“We always start with lifestyle changes, minimizing the rich, fatty foods and caffeine that can stimulate acid reflux,” Hachem says. “We counsel patients to lose weight, cut back on alcohol and stop smoking.” Standard acid reflux precautions also include not lying down within four hours of your last meal.

“If those steps are not successful, we talk about medications,” Hachem continues. “For mild heartburn, over-the- counter medications can work very well,” Weinstock adds. “If the condition is more regular but still mild, we recommend H2 blockers like Pepcid and Zantac. For more severe cases, people will take proton pump inhibitors—Prilosec and Nexium.” Some patients may even need surgery to tighten the lower sphincter.

“Acid reflux can become quite serious,” Hachem says. “Patients may have chest pains and trouble swallowing. Chronic or long-standing acid reflux that is not wellcontrolled can progress to a precancerous condition called Barrett’s esophagus, which can lead to esophageal cancer. Recognize the symptoms, then talk to a doctor to see if more testing needs to be done.”

hair loss
We’re finding more and more that many health issues can be controlled through lifestyle changes: diet, exercise, relaxation, etc. But one common problem is set even before you know you’ve got it: androgenic alopecia, or hair loss. You have your ancestors to thank for that.

it’s inevitable
“The vast majority of hair loss in men and women is inherited in a condition that causes hair follicles to be susceptible to the hormone dihydrotestosterone, or DHT,” says Dr. Richard Moore of The Lifestyle Center. “By age 40, approximately 40 percent of women and more than 50 percent of men are affected by significant hair loss.”

Dr. Gregory Chambon of Hair Dr. believes hair loss is occurring in ever-younger people. “I am baffled by how early it can occur,” he says. “We are averaging patients who are in their 20s and early 30s.” Some people have hair follicles that are simply more susceptible to DHT, says Moore, and “contrary to prior thinking, both Mom’s and Dad’s genetics contribute to this trait.”

Most male hair loss, and much in females, is male pattern baldness, the term for androgenic alopecia. The hairline marches backward from the forehead, and follicles gradually abandon the head’s crown. Women also may encounter alopecia areata, Chambon says. “This is more of an autoimmune condition that causes patchy hair loss around the head.”

hair today, hair tomorrow
“Low-level laser therapy has been shown to increase the growth of hair follicles and hair density when used on a consistent basis,” Moore says. Platelet-rich plasma, enriched blood plasma, also has been shown to increase hair density, he adds. “This involves injections into the scalp, and effects
can last two years or more.”

In terms of noninvasive therapies, “Biotin is a B vitamin that has been well studied and is good for the overall health of the hair, skin and nails,” Chambon says. And Rogaine (minoxidil) has been shown to slow hair loss and increase hair density, although Chambon says, “Its proven benefits have been restricted to the crown region.” Moore says these treatments have response rates of 80 to 90 percent, but it takes up to one year to see the full benefit, and they must be continued long-term.

Rogaine illustrates an important point: the head grows different types of hair. “Even if a guy goes totally bald, he still has hair on the back and sides of his head,” Chambon says. “Those follicles, we have found, have different DNA, which makes them not susceptible to male-pattern baldness.”

splitting hairs
That feature makes hairs from the back and sides useful for transplants to the hairline and top of the head. “Once transplanted, these follicles are permanent—they are no longer susceptible to the effects of DHT,” Moore explains. “The trend has been moving away from the surgical strip method, where a section of skin is excised from the scalp, and moving toward follicular unit extraction, where individual follicles are removed from the back of the scalp for implantation.”

That is good news for translplant patients, since the strip method left a linear scar, Chambon says. His office uses a NeoGraft machine for follicle transplantation. “It has a onemillimeter blade that lifts out a follicle, and we use a very small needle to make holes to place that follicle,” Chambon says. “With that needle, we can affect the angle of the hair to work with the existting hair or make the hairs work well together when they are grown out and combed.” Most men will need 1,500 to 2,500 follicles to be transplanted, Chambon says.