Deciding whether or not to have surgery when you’re older; flexitarian diet

Q: I’m 82 and could benefit from a hip replacement, but a lot of folks, including some of my doctors, say it’s too risky at my age. I would really like to be able to walk without pain. How do I figure out what’s smart to do — or not do? — Gerald F., Cleveland

A: So many things that affect the outcome have to be taken into consideration. Most important is your physiologic age or what I call your Realage. Next is your posse (support system), and then your specific health conditions, the medications you take, your history of reaction to anesthesia, and your ability and willingness to do post-surgical rehab.

Around a million major surgeries are done on folks 65+ every year in this country. (Major surgeries are invasive procedures, done in an operating room, using general anesthesia.) And almost one in seven of those folks die within a year of their operation. General

frailty contributes to the risk, as does having previous heart disease or increased susceptibility to infection. Older patients with probable dementia are especially at risk — a third die within a year. Having emergency surgery triples the risk.

The reasons for these alarming statistics are, as I said, complex. You and your doctors need to take all this into consideration — and to discuss the remarkable power of physical therapy to ease joint pain and make you better prepared to sail through surgery if you choose to have it.

Harvard Medical School says “The main component of joint surgery avoidance is strengthening the muscles that support your joints,” and suggests exercises that strengthen gluteal muscles in the buttocks and flexors in the pelvis.

Beyond PT, you can make a huge difference in your surgical risks by rebooting your age at Greatagereboot.com. At 80, you can become about 30 years younger than your calendar age and that means your risk of surgery would be 1/27 of that of someone whose Realage is 80.

Q: I just read that the Mediterranean, the DASH and something called the Flexitarian diet are the three healthiest choices. What is Flexitarian and is it a smart way to eat? — Jaclyn E., Des Moines, Iowa

A: The Mediterranean diet centers on eating less animal foods (with an emphasis on healthy fish), more fruits and vegetables, more legumes, more healthy fats like olive oil and having a glass of wine a day. The DASH diet, originally designed to lower elevated blood pressure, is similar to the Med diet with the additional emphasis on low-sodium, unprocessed foods — and no wine. Research supports the benefits of both of those approaches. They help reduce chronic inflammation and lower your diabetes risk and boost heart health and gut biome and immune system function, while helping you maintain or achieve a healthy weight.

The Flexitarian diet is a “mostly vegetarian” way to reclaim and hold on to your health. The aim is to increase the number of meat-free days and reduce your saturated fat intake. The animal proteins you do eat occasionally should be more healthful, like salmon and skinless poultry. (Although the original diet said red meats were OK sometimes, I don’t agree.)

One recent study found that the Flexitarian diet nurtures maximal gut microbiome diversity — and that improves cognition and gives you a more robust resistance to infection and some cancers. Another study found that this mostly vegetarian approach helps lower lousy LDL cholesterol levels and reduces blood pressure.

Just make sure you get enough calcium on this diet by eating plenty of calcium-rich dark leafy greens, almonds, edamame and tofu — and canned salmon and sardines with bones if you want. If you enjoy dairy, choose reduced or nonfat products.

If this appeals to you and you can stick with it for the long run, I think it’s a good choice. It will help you live younger longer — but don’t compromise by having red meat, processed meat or egg yolks.

Health pioneer Michael Roizen, M.D., is chief wellness officer emeritus at the Cleveland Clinic and author of four No. 1 New York Times bestsellers. His next book is “The Great Age Reboot: Cracking the Longevity Code for a Younger Tomorrow.” Do you have a topic Dr. Mike should cover in a future column? If so, please email questions@ Greatagereboot.com.