Overcome Your Fear of Public Speaking With These Strategies

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Q: Whenever I have to speak in front of a group, I freak out. Help!

OK, deep breath: Fear of public speaking is fairly common and quite treatable. It’s considered a social anxiety disorder, which causes people to feel so worried about being judged and embarrassed in social situations that they avoid them altogether. Stage fright, which is what you are describing, is specifically the fear of speaking in front of an audience because you imagine them having negative thoughts about your performance or you as a person.

RELATED: 19 Natural Remedies for Anxiety

The good news is that you can overcome the anxiety. First, try doing relaxation techniques 10 minutes before getting up in front of a crowd, such as deep breathing or yoga; that should calm you down. You can also try writing down exactly what you fear and think might happen. Then challenge the scenario: Is it really likely that everyone in the room will laugh when you open your mouth? And even if they did, so what? (Therapists call this exercise “cognitive restructuring.”) Another treatment strategy is exposure—simply doing what you’re scared of so often that you become desensitized to the fear of it. Since it can be hard to find many opportunities to speak publicly, a number of psychiatric clinics have virtual reality simulators that allow patients to practice in front of a virtual audience.

RELATED: The Best (and Worst) Ways to Cope With Stress

In some cases, it’s necessary to decrease your body’s stress response to your fear. Ask your doctor whether you might benefit from a beta-blocker medication; this type of drug helps keep your blood pressure low and your pulse slow, which often makes your body—and in turn your mind— feel calm. If you go this route, road-test the medication to see how well you tolerate it before using it prior to an important public affair. Some people have low blood pressure normally, and taking a beta-blocker causes them to faint.

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Turning Blue Temporarily Sometimes Normal for Babies, Doctors Say

By Dennis Thompson
HealthDay Reporter

MONDAY, April 25, 2016 (HealthDay News) — It’s a heart-stopping moment experienced by many parents — they discover their baby has turned blue, is breathing irregularly, or won’t respond to a gentle wake-up nudge. Yet, mere seconds later the infant is back to normal.

Fortunately, these events are less dire than one might think. But they’re also more common, an expert panel from the American Academy of Pediatrics (AAP) concluded.

The AAP panel has coined a new term for these events, to reflect the fact that they are rarely associated with a serious underlying medical problem.

The new term, “brief resolved unexplained events” or BRUE, replaces the previous term, “apparent life-threatening events” or ALTE, said Dr. Joel Tieder, lead author of the new AAP clinical practice guideline. Tieder is an associate professor of medicine at Seattle Children’s Hospital.

A BRUE is transient in nature, and has no clear cause, the new guideline said.

BRUE episodes happen in babies younger than 1 year of age when one or more of the following conditions occurs:

• Turning blue or pale,
• Irregular, decreased or halted breathing,
• A marked change in muscle tone,
• Unresponsiveness.

The episode must last less than a minute, and then resolve itself on its own, the panel said.

“Infants probably do these things regularly and we don’t know it,” said Dr. Ian Holzman, chief of newborn medicine at Mount Sinai Hospital in New York City. “I think that’s the gist of it. This is something that’s not a disease, not a sickness. It happens, and you don’t have to get crazy about it.”

Tieder explained that the term ALTE was applied to these events back in the 1980s, when doctors thought they might be precursors to sudden infant death syndrome (SIDS).

But ALTE was poorly defined and led to many children being hospitalized and receiving unnecessary testing, Tieder said. Pediatricians would draw blood, attach EKG wires and order radiation-laden imaging scans, but often found nothing wrong with the child.

“Those tests oftentimes didn’t lead to a diagnosis, and when they did lead to a diagnosis it wasn’t something that wasn’t a treatable diagnosis,” Tieder said. “We really had to ask the question, are we doing more harm for these families than good?”

In addition, research has since determined that these events are not related to SIDS, Tieder added, noting that this finding is very reassuring for parents.

BRUE will be applied to cases based on more tightly defined criteria than those given to ALTE, he said.

Pediatricians can diagnose an event as BRUE only after performing a physical examination and taking a medical history, which is another marked change from the way ALTE was applied, Tieder explained. Doctors often diagnosed ALTE based solely on what they were told by the parent or caregiver.

The truth is, these sort of events just happen to babies, the AAP panel concluded.

Tieder noted a key study that tracked about 1,000 infants over a couple of weeks on home monitors. “When you look at those kids, even the healthy kids, these types of events were quite common,” he said. But, he added, they’re not always seen in the health care setting.

The BRUE episodes are related to things that occur regularly to infants. “Infants don’t come with a manual, and they do things parents wouldn’t expect,” Tieder said.

For example, it’s part of normal infant physiology to stop breathing for brief periods, or to occasionally turn blue at the mouth or feet, he said. Sometimes infants sleep so deeply that they appear unresponsive.

Holzman doesn’t expect any controversy over the new term BRUE, although there may be a short period of “rocky disagreements for what needs to be done for children who are now BRUE.”

The AAP expert panel recommends against subjecting kids with “low-risk” BRUE to hospitalization or testing.

Babies with “high-risk” BRUE are those who:

• Were born premature,
• Are younger than 2 months old,
• Have had repeated BRUE episodes,
• Have had an event that lasted longer than one minute or required CPR from a trained medical professional,
• Had a finding of concern in their physical exam or medical history.

These “high-risk” kids should be given a closer look to make sure nothing’s wrong, Tieder said.

Although the new term is meant to reassure parents, babies should still be examined by a doctor following what appears to be a BRUE episode, Tieder and Holzman said.

“The important part is that the baby otherwise seems fine, but I think it still merits some other person making sure the child is healthy,” Holzman said.

The new AAP clinical guideline was released online April 25 and published in the May print issue of the journal Pediatrics.

More information

Learn more about common conditions in newborns from the American Academy of Pediatrics.

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Turning Blue Temporarily Sometimes Normal for Babies, Doctors Say

By Dennis Thompson
HealthDay Reporter

MONDAY, April 25, 2016 (HealthDay News) — It’s a heart-stopping moment experienced by many parents — they discover their baby has turned blue, is breathing irregularly, or won’t respond to a gentle wake-up nudge. Yet, mere seconds later the infant is back to normal.

Fortunately, these events are less dire than one might think. But they’re also more common, an expert panel from the American Academy of Pediatrics (AAP) concluded.

The AAP panel has coined a new term for these events, to reflect the fact that they are rarely associated with a serious underlying medical problem.

The new term, “brief resolved unexplained events” or BRUE, replaces the previous term, “apparent life-threatening events” or ALTE, said Dr. Joel Tieder, lead author of the new AAP clinical practice guideline. Tieder is an associate professor of medicine at Seattle Children’s Hospital.

A BRUE is transient in nature, and has no clear cause, the new guideline said.

BRUE episodes happen in babies younger than 1 year of age when one or more of the following conditions occurs:

• Turning blue or pale,
• Irregular, decreased or halted breathing,
• A marked change in muscle tone,
• Unresponsiveness.

The episode must last less than a minute, and then resolve itself on its own, the panel said.

“Infants probably do these things regularly and we don’t know it,” said Dr. Ian Holzman, chief of newborn medicine at Mount Sinai Hospital in New York City. “I think that’s the gist of it. This is something that’s not a disease, not a sickness. It happens, and you don’t have to get crazy about it.”

Tieder explained that the term ALTE was applied to these events back in the 1980s, when doctors thought they might be precursors to sudden infant death syndrome (SIDS).

But ALTE was poorly defined and led to many children being hospitalized and receiving unnecessary testing, Tieder said. Pediatricians would draw blood, attach EKG wires and order radiation-laden imaging scans, but often found nothing wrong with the child.

“Those tests oftentimes didn’t lead to a diagnosis, and when they did lead to a diagnosis it wasn’t something that wasn’t a treatable diagnosis,” Tieder said. “We really had to ask the question, are we doing more harm for these families than good?”

In addition, research has since determined that these events are not related to SIDS, Tieder added, noting that this finding is very reassuring for parents.

BRUE will be applied to cases based on more tightly defined criteria than those given to ALTE, he said.

Pediatricians can diagnose an event as BRUE only after performing a physical examination and taking a medical history, which is another marked change from the way ALTE was applied, Tieder explained. Doctors often diagnosed ALTE based solely on what they were told by the parent or caregiver.

The truth is, these sort of events just happen to babies, the AAP panel concluded.

Tieder noted a key study that tracked about 1,000 infants over a couple of weeks on home monitors. “When you look at those kids, even the healthy kids, these types of events were quite common,” he said. But, he added, they’re not always seen in the health care setting.

The BRUE episodes are related to things that occur regularly to infants. “Infants don’t come with a manual, and they do things parents wouldn’t expect,” Tieder said.

For example, it’s part of normal infant physiology to stop breathing for brief periods, or to occasionally turn blue at the mouth or feet, he said. Sometimes infants sleep so deeply that they appear unresponsive.

Holzman doesn’t expect any controversy over the new term BRUE, although there may be a short period of “rocky disagreements for what needs to be done for children who are now BRUE.”

The AAP expert panel recommends against subjecting kids with “low-risk” BRUE to hospitalization or testing.

Babies with “high-risk” BRUE are those who:

• Were born premature,
• Are younger than 2 months old,
• Have had repeated BRUE episodes,
• Have had an event that lasted longer than one minute or required CPR from a trained medical professional,
• Had a finding of concern in their physical exam or medical history.

These “high-risk” kids should be given a closer look to make sure nothing’s wrong, Tieder said.

Although the new term is meant to reassure parents, babies should still be examined by a doctor following what appears to be a BRUE episode, Tieder and Holzman said.

“The important part is that the baby otherwise seems fine, but I think it still merits some other person making sure the child is healthy,” Holzman said.

The new AAP clinical guideline was released online April 25 and published in the May print issue of the journal Pediatrics.

More information

Learn more about common conditions in newborns from the American Academy of Pediatrics.

---

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Expert Offers Advice on Treating Corns, Calluses

SUNDAY, April 24, 2016 (HealthDay News) — Corns and calluses form due to friction or pressure on the skin, and there are a number of ways to treat these often unsightly areas, an expert says.

“Calluses can develop anywhere on the body where there is repeated friction, such as a guitar player’s fingertips or a mechanic’s palms,” said Dr. Nada Elbuluk, assistant professor of dermatology at NYU Langone Medical Center in New York City.

“Corns typically develop on the tops and sides of the toes, and on the balls of the feet, and common causes are arthritis or poorly fitting shoes,” she explained in an American Academy of Dermatology news release.

Elbuluk also noted that corns and calluses on the feet may be mistaken for plantar warts. But plantar warts have tiny black dots in them, which are actually small blood vessels. And, plantar warts are usually more painful when pressure is applied to the sides of the warts, she explained.

If corns and calluses are an issue for you, Elbuluk offered some tips for treating them.

You can soak your corn or callus in warm water for five to 10 minutes or until the skin softens, she suggested. Then, use a pumice stone to file the corn or callus. First dip the stone in warm water and then use circular or sideways motions to remove dead skin. Don’t remove too much skin because doing so could cause bleeding and infection, she advised.

Another approach is to apply moisturizing lotion or cream with salicylic acid, ammonium lactate, or urea to the area each day. This will help gradually soften corns and calluses, Elbuluk explained.

To prevent further irritation of calluses, cut a piece of moleskin into two half-moon shapes and place them around the callus. For corns, surround them with donut-shaped adhesive pads. These products are available at most drugstores.

Shoes that aren’t the right size or shape for your foot are a common cause of corns, Elbuluk noted. It’s best to shop for shoes at the end of the day, when your feet may be slightly swollen. Ask the clerk to measure your foot, and don’t buy shoes that are too loose or tight, she advised.

And keep your toenails trimmed, Elbuluk said. If they’re too long, toenails can force your toes up against your shoes, causing a corn to form.

“Most corns and calluses gradually go away when the friction or pressure causing them stops,” Elbuluk said in the news release.

But if you don’t know what caused your corn or callus, or if the hardened skin is very painful, Elbuluk recommended seeing a certified dermatologist, podiatrist or orthopedist. She said people who think they have warts, and people with diabetes, should also see a doctor for their corns and calluses.

More information

The American Podiatric Medical Association has more about corns and calluses.

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Swim Safely This Summer

SATURDAY, April 23, 2016 (HealthDay News) — With the arrival of swimming season, the American Red Cross reminds people of all ages to follow safety rules at the beach or pool.

Swim in designated areas supervised by lifeguards and always swim with a buddy. Everyone in your family should learn to swim well.

Young children and inexperienced swimmers should wear U.S. Coast Guard-approved life jackets when around water, but do not rely on life jackets alone. Children should never be left unattended near water. And adults should teach children to always ask permission to go near water, the Red Cross says.

Keep a constant eye on children and avoid distractions when supervising kids around water. If a child is missing, check the water first. Seconds can make the difference between no lasting harm and disability or death, the Red Cross warns.

If you have a pool, secure it with appropriate barriers and have safety equipment, such as reaching or throwing devices, life jackets, a first aid kit and a cellphone, the Red Cross advises. Know how and when to call 911 or the local emergency number.

Take water safety, first aid and other training classes so you know how to prevent and respond to emergencies, the experts say.

More information

The California Department of Water Resources has more on water safety.

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No Link Between Anti-Smoking Drugs, Mental Health Issues: Study

FRIDAY, April 22, 2016 (HealthDay News) — The anti-smoking drugs Chantix (varenicline) and Wellbutrin (bupropion) don’t appear to raise the risk of serious mental health disorders such as depression, anxiety and suicidal thoughts, a new study suggests.

“Clinical guidelines recommend that the most effective way to give up smoking is smoking cessation medication and counseling. However, smokers do not use these services enough, in part due to concerns that the medications may not be safe,” said lead author Dr. Robert Anthenelli, professor of psychiatry at University of California, San Diego.

The new study, published April 22 in The Lancet, should help ease those concerns for patients, the researchers said.

The study was requested by the U.S. Food and Drug Administration due to concerns about the safety of the drugs used to help people quit smoking. Funding was provided by drug makers Pfizer (which makes Chantix) and GlaxoSmithKline (maker of Wellbutrin).

The research included more than 8,000 people between the ages of 18 and 75. They smoked an average of more than 10 cigarettes a day and wanted to quit smoking. Half had a previous or current psychiatric condition, such as a mood, anxiety, psychotic or borderline personality disorder, while about half of those participants were taking medications for their conditions.

The participants were randomly assigned to one of four possible groups: to take either Chantix or Wellbutrin, to use nicotine patches or to take a placebo.

They were assessed for moderate-to-severe mental health problems such as agitation, aggression, panic, anxiety, depression and suicidal thoughts during up to three months of treatment and at follow-up (up to six months).

Among those with no psychiatric disorders, there was no significant increase in the incidence of mental health problems in the four groups. While more mental health problems occurred among participants with psychiatric disorders, the rates were similar for all four groups, the study found.

The researchers also examined quit rates and found that varenicline was the most effective. At follow-up, overall quit rates were: 22 percent, Chantix; 16 percent, Wellbutrin; 16 percent, nicotine patches; and 9 percent, placebo.

Quit rates were slightly lower for those with a psychiatric disorder, the study said.

Anthenelli said the findings from this study and previous ones make it unlikely that these drugs increase the risk of moderate-to-severe mental health side effects in smokers without psychiatric disorders.

The study results “show that neuropsychiatric adverse events occurring during smoking cessation are independent of the medication used,” addiction expert Laurie Zawertailo wrote in an accompanying editorial.

“Clinicians should be comfortable prescribing the smoking cessation medication they feel would be most effective for their patient and should not worry about a specific medication increasing the risk of neuropsychiatric side effects,” said Zawertailo, an assistant professor in the department of Pharmacology and Toxicology at the University of Toronto.

She added that patients who are trying to quit need to know that severe changes in their mood can occur.

“Clinicians should monitor all of their patients, especially those with a current or past psychiatric illness, for these changes,” Zawertailo said. “This monitoring could be added to the behavioral counseling that clinicians should be providing to patients who are trying to quit smoking.”

Two experts in helping smokers quit said the findings are valuable for patients.

“In my experience there has been reluctance among many practitioners to prescribe varenicline and/or bupropion for their tobacco-dependent patients, due to concerns about potential neuropsychiatric adverse events,” said Patricia Folan. She directs the Center for Tobacco Control at Northwell Health in Great Neck, N.Y.

She said many smokers also look for information on quit-smoking aids on the internet, and “frequently decide to avoid these medications because of the reported side effects — resulting in their continued smoking.

“Demonstrating the safety and efficacy of these cessation treatment options for tobacco users will most likely lead to additional quit attempts and quit success,” Folan believes.

Dr. Len Horovitz is a pulmonary specialist at Lenox Hill Hospital in New York City. He agreed that, based on the new findings, “medication-assisted smoking cessation is safe and freer from side effects than patients — and doctors — may fear.”

More information

The American Cancer Society offers a guide to quitting smoking.

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Most Americans Turn to Prayer for Healing Survey Finds

FRIDAY, April 22, 2016 (HealthDay News) — When it comes to dealing with illness, most Americans turn to a higher power for help, a new study suggests.

“Outside of belief in God, there may be no more ubiquitous religious expression in the U.S. than use of healing prayer,” study author Jeff Levin said in a Baylor University news release. Levin is the director of the program on religion and population health at Baylor University in Texas.

About 87 percent have prayed for healing for others, the study found. Just over half said they did so often, according to a 2010 survey of more than 1,700 adults across the United States.

Almost 80 percent of Americans reported praying for healing for themselves at some point in their lives. Nearly one-third said they did so often, the survey showed.

About 54 percent have asked for prayers for their health, 26 percent have given a “laying on of hands” for healing, and 53 percent have been part of a prayer group, prayer circle or prayer chain, the study found.

“The most surprising finding is that more than a quarter of all Americans have practiced laying on of hands — and nearly one in five has done so on multiple occasions,” Levin said.

The practice of laying on of hands has long been used by Christians and Jews as a means to ordain clergy and to bless people, but also to transmit physical healing, Levin explained in the news release.

“Interestingly, most people who use prayer for healing do so alongside regular medical care, rather than as a substitution, as has been presumed up to now,” he added.

The study was published online April 13 in the Journal of Religion and Health.

More information

The U.S. National Cancer Institute has more about spirituality in cancer care.

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New Guidelines Issued on Breast Genital Plastic Surgery for Teen Girls

By Amy Norton
HealthDay Reporter

FRIDAY, April 22, 2016 (HealthDay News) — A growing interest among teenaged girls in plastic surgery on their breasts or genitals has prompted a leading ob/gyn group to recommend that doctors first talk to these young women about “normal” sexual development.

“Our membership has been telling us this is coming up more and more frequently with their adolescent patients,” said Dr. Julie Strickland. She is chair of the Adolescent Health Care Committee of the American College of Obstetricians and Gynecologists (ACOG).

The new recommendations also suggest that physicians screen these patients for body dysmorphic disorder, which is an obsession with an imagined or slight defect in appearance.

There are already guidelines from the American Society of Plastic Surgeons (ASPS) on breast augmentation and reduction among teenagers. If it’s strictly for cosmetic reasons, the society recommends surgery should generally be delayed until age 18.

But, Strickland said, there’s no guidance for cases where teenagers want labiaplasty — where surgery is used to reduce the inner labia, the folds of skin that surround the vaginal opening.

Normal labia come in all sizes and shapes, Strickland said, and there’s no widely accepted definition of labial “hypertrophy,” or enlargement. Nor are there clear guidelines on when surgery might be appropriate for teenagers.

The new guidelines appear in the May issue of Obstetrics & Gynecology.

When girls are worried about the appearance of their breasts or genitals, Strickland said, the anxiety can often be “diffused” by letting them know there is a wide variation in “normal” development.

Even in this day and age, she noted, many girls do not know what their genitals are “supposed” to look like. “Despite all of the anatomy books that have been published over the years, we’re lacking in descriptions of normative female genital development,” Strickland said.

Nationwide, about 8,000 13- to 19-year-olds underwent breast augmentation in 2014, according to the ASPS. Statistics on breast reduction are harder to come by, but in 2010 about 4,600 were performed on 13- to 19-year-olds.

The ASPS does not track labiaplasty figures, and it’s not clear how many teenagers have the procedure each year, according to ACOG.

No one knows exactly why teenagers are voicing more concerns about their labial development, either, Strickland said.

“One theory is that girls these days are seeing images of ‘idealized’ bodies,” Strickland said. “There have also been cultural changes, with more girls grooming their pubic hair. That may make them more self-conscious about the appearance of their genitals.”

Then there are the yoga pants and other form-fitting clothes that can either make girls scrutinize their appearance, or be physically uncomfortable, she added.

And it is actually physical discomfort that seems to be the main issue for teenage girls who want labiaplasty, said Dr. David Song, president of the ASPS. Song is also chief of plastic and reconstructive surgery at the University of Chicago.

“It’s pretty rare to have a teenager coming in for cosmetic reasons,” Song said.

When the inner labia protrude from the outer labia, he explained, it can be “very uncomfortable” to wear tighter clothing, or to exercise at all. In those cases, surgery to reduce the inner labia may help a girl feel better physically and emotionally, Song said.

He agreed that it’s important to be sure teenagers are mature enough, and fully informed of the risks, before any plastic surgery. With labiaplasty, ACOG says, the potential risks include infection, scarring, and pain during sex.

According to Song, board-certified plastic surgeons are also trained to screen for body dysmorphic disorder and other mental health issues, like depression.

“They understand when they should be referring patients to a mental health professional,” Song said.

That’s why it’s key, he added, for parents and young women to make sure they’re seeing a surgeon who is board-certified.

When it comes to breast surgery, the ASPS does recommend that it generally be delayed to age 18. But, Song said, the issue is “not black-and-white,” and there are cases where earlier may be better.

An example, he said, would be a younger teen whose breast growth is far out of proportion to the rest of her body — to the point that it’s causing her physical discomfort.

According to Strickland, the bottom line for parents is this: Listen to your daughter’s concerns about her development, and be able to reassure her that she’s going through normal changes. If you’re not sure of what’s “normal,” talk to your pediatrician or family doctor, Strickland said.

“It’s typical for teenagers to question whether they’re ‘normal’ or not,” she noted. “So we shouldn’t be ‘horrified’ if they come to us with these questions. We need to respond sensitively and honestly.”

More information

The U.S. National Library of Medicine has more on teens’ sexual development.

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Could Certain Fatty Foods Be Linked to Aggressive Prostate Cancer?

FRIDAY, April 22, 2016 (HealthDay News) — What men eat — particularly fatty meats and cheese — may affect how quickly their prostate cancer progresses, a new study suggests.

“We show that high dietary saturated fat content is associated with increased prostate cancer aggressiveness,” said study author Emma Allott, a research assistant professor at the Gillings School of Global Public Health at the University of North Carolina.

“This may suggest that limiting dietary saturated fat content, which we know is important for overall health and cardiovascular disease prevention, may also have a role in prostate cancer,” she said in a school news release.

However, the study did not prove that diet directly affects prostate cancer behavior, only that there is a link between those factors.

The researchers looked at more than 1,800 men from North Carolina and Louisiana. All had been diagnosed with prostate cancer between 2004 and 2009. They were asked about their eating habits and other factors at the time of their diagnosis.

Higher intake of saturated fat from foods such as fatty beef and cheese was linked with more aggressive prostate cancer, the researchers found.

A diet high in saturated fat contributes to higher cholesterol levels, researchers said. They noted that the link between saturated fat and aggressive prostate cancer was weaker in men who took cholesterol-lowering statin drugs.

The researchers said that suggests that statins reduce, but don’t completely reverse, the effect that high amounts of saturated fat may have on prostate cancer.

The study also found that higher levels of polyunsaturated fats, found in foods such as fish and nuts, were associated with less aggressive prostate cancer.

Further research is needed to learn more about why a diet high in saturated fat is linked with more aggressive prostate cancer, Allott said.

The researchers presented their findings April 18 at the annual meeting of the American Association for Cancer Research in New Orleans. Findings presented at meetings are generally viewed as preliminary until they’ve been published in a peer-reviewed journal.

More information

The U.S. National Cancer Institute has more on prostate cancer.

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These Are the Genes Behind Healthy Aging

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Most studies about disease focus on people who are sick, since people with a disease are very likely to show whatever genetic or other biological changes are responsible for their condition.

But researchers are starting to find the flip side to that strategy attractive—studying people, rare though they might be, who have whatever changes are responsible for disease but somehow don’t get sick. Could they provide clues about how they’re able to overcome their biological condition and remain healthy despite being dealt a bad biological hand?

That’s the question that Dr. Eric Topol, director of the Scripps Translational Science Institute, and his colleagues wanted to investigate for healthy aging. While certain diseases such as heart problems, cancer, dementia and diabetes are more common with age, there are some people who remain remarkably immune to their effects and who are able to stay intellectually sharp and physically robust well into their 80s, 90s and even 100s. Topol and his team enrolled a group of these people they called the Wellderly: those older than 80 years with no chronic diseases and who did not take any medications for chronic illnesses. Of the 1,354 people in the study, 511 had their entire genomes sequenced, and over eight years, the researchers performed in-depth analysis of their DNA and compared their results to those from similarly aged people who did have the typical chronic diseases associated with aging.

RELATED: The Cure for Aging

To their surprise, Topol’s group reports in the journal Cell that it wasn’t genes associated with long life that set the Wellderly apart. In fact, there was little correlation between the genes that had already been identified as contributors to longevity and the genes that distinguish the Wellderly, who live long but are also relatively free of disease. “The healthy aging really seems to be a separate group that stay free of chronic disease versus the man-made long-lived person who may have a heavy chronic disease burden but is being kept alive with modern medicine,” says Topol. “We thought there would be a lot of overlap, but there wasn’t.”

What did set the Wellderly apart was a set of genes that related to their cognitive function. They were less likely to have the deleterious form of the ApoE gene that is linked to a higher risk of Alzheimer’s disease. They also found, however, that this group had higher rates of a rare variant of a gene that secretes proteins in the brain attracted to amyloid. Amyloid is the protein that builds up abnormally in the brains of Alzheimer’s patients, so this version of the gene is now an appealing target for some type of protective factor that may sponge up damaging amyloid before it causes Alzheimer’s. A drug that mimics the effects of this unusual form of the gene might be a way to help avoid Alzheimer’s.

RELATED: How to Live to 100: Researchers Find New Genetic Clues

But that’s just one way that people may be aging in good health. Topol says that it’s likely that for healthy aging, it’s necessary to both have genes that lower the risk of chronic diseases (such as avoiding the harmful form of ApoE) as well as having genes that confer some type of protection against the damaging effects of chronic illnesses (such as the newly identified and rare variant of the brain gene). “There are probably hundreds of protective variants,” he says.

What this study highlights is that the only way to identify them is to study people who age well, without disease, since some of the genetic contributions to their healthy state might be rare. It’s also important to conduct whole genome sequencing on these people to fully understand any useful clues their DNA may hold. “It’s like finding nature’s secrets to how people stay healthy,” says Topol. “Learning things from nature rather than mining libraries of molecules for potential healthy aging drugs seems like it can be highly constructive.”

This article originally appeared on Time.com.

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