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What the Nun Study Teaches Us About Leading Longer, Healthier, and More Meaningful Lives

Written by David SnowdonAuthor Alerts:  Random House will alert you to new works by David Snowdon


List Price: $13.99


On Sale: November 19, 2008
Pages: 256 | ISBN: 978-0-307-48123-8
Published by : Bantam Bantam Dell
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In 1986 Dr. David Snowdon, one of the world’s leading experts on Alzheimer’s disease, embarked on a revolutionary scientific study that would forever change the way we view aging—and ultimately living. Dubbed the “Nun Study” because it involves a unique population of 678 Catholic sisters, this remarkable long-term research project has made headlines worldwide with its provocative discoveries.
Yet Aging with Grace is more than a groundbreaking health and science book. It is the inspiring human story of these remarkable women—ranging in age from 74 to 106—whose dedication to serving others may help all of us live longer and healthier lives.

Totally accessible, with fascinating portraits of the nuns and the scientists who study them, Aging with Grace also offers a wealth of practical findings:

• Why building linguistic ability in childhood may protect against Alzheimer’s
• Which ordinary foods promote longevity and healthy brain function
• Why preventing strokes and depression is key to avoiding Alzheimer’s
• What role heredity plays, and why it’s never too late to start an exercise program
• How attitude, faith, and community can add years to our lives

A prescription for hope, Aging with Grace shows that old age doesn’t have to mean an inevitable slide into illness and disability; rather it can be a time of promise and productivity, intellectual and spiritual vigor—a time of true grace.


The Road to Good Counsel Hill

They will open up to you, but only if you give of yourself first.
--Sister Carmen Burg

On a spring morning in 1986, when the midwestern snowpack finally had begun to melt and the change of seasons encouraged new ideas to sprout, I sat nervously in the reception room of a convent in St. Paul, Minnesota, with a new idea of my own. I had come here to meet Sister Carmen Burg, who would either help my idea take root or wish me luck and send me on my way. I feared that she had bad news for me.

As an assistant professor of epidemiology at the University of Minnesota, I was struggling mightily to find my niche. In the competitive world of scientific research, especially at a large institution, I knew I had little time to establish my value to the department. All too frequently I remembered my chairman's words: "It's nice to be independent, but you must be funded."

Sister Carmen was an elected leader of one of Minnesota's largest groups of Catholic nuns, the School Sisters of Notre Dame. Nearly two hundred sisters lived at the Good Counsel Hill convent in Mankato, ninety miles southwest of St. Paul. I had contacted Sister Carmen to propose a research project involving the nuns. Now I worried that she had offered to meet me here--before I ever got to Mankato--so that it would be less awkward to turn me down. Underscoring my anxiety were images that had been seared into my memory at Sacred Heart elementary school. Most of the sisters had been serious, take-no-prisoners disciplinarians.

I had learned what I knew about the School Sisters of Notre Dame from Nora Keenan, a graduate student in our department. Nora had an unusual background for an epidemiologist: She had previously been one of the Notre Dames and had lived at the Mankato convent. She explained to me that her former congregation had originated in Bavaria in 1833, at a time of great political and social upheaval.

The founder was a teacher at a parochial school, Caroline Gerhardinger, who later took the religious name Mary Teresa of Jesus. Mother Teresa, as she was known, believed that society could be transformed through the family, and that her call was to provide education and spiritual formation for girls--particularly poor girls in rural areas. Shortly after the congregation was established, millions of Germans--driven by crop failure and revolution--began to emigrate to the United States, and the American bishops asked Mother Teresa to consider a new frontier for her mission.

Together with four other sisters, she arrived at a forest settlement in Pennsylvania in 1847. From there, the congregation had moved west and south with the immigrants, founding schools and convents throughout North America. By 1986, the congregation (now based in Rome) had more than seven thousand sisters in nearly thirty countries. The Mankato convent--one of seven provincial motherhouses in this country--had been established in 1912.

Nora's account immediately sparked my interest. As I told her one day over lunch, I had built my career so far around studying unique populations of religious groups. For my Ph.D. thesis at Minnesota, I had joined an ongoing study of the Lutheran Brotherhood and investigated whether cancer and heart disease had any links to alcohol use. I then worked at California's Loma Linda Medical College, investigating the impact of diet on the health of Seventh-day Adventists. Now that I was back at Minnesota, I wanted to study aging and health, and I suspected that nuns or priests--I did not really have a preference--would offer unique clues. It was then that Nora had offered an introduction to Sister Carmen.

My nervous wait ended when a short, smiling woman came into the reception room and held out her hand. Sister Carmen was dressed in a simple white blouse, camel-colored cardigan, and long plaid skirt. Only a small pin over her heart signaled her membership in the School Sisters of Notre Dame. I had forgotten that since my days at Sacred Heart school, the reforms of the Second Vatican Council (or Vatican II) had made the black-and-white habit an option. Now in her early sixties, Sister Carmen wore large glasses, and behind them I could see the intelligent, patient eyes of a woman who had taught thousands of children. After we had chatted for a few minutes, she got right to the point.

"You know, Dr. Snowdon," she said in her distinct midwestern accent, "I love being a nun. Sisters are as human as the next person. But my question is, why on earth do you want to study nuns?"

She listened attentively as I described my past work with Lutherans and Adventists. I explained to Sister Carmen that these religious groups kept extensive membership lists and historical records that made them ideal subjects for epidemiological studies. And the members often had similar lifestyles, which enabled researchers to make powerful comparisons of factors connected to illness or health. Nuns had even more similar histories. They do not smoke. They are celibate. They have similar jobs and income, and they receive similar health care for most of their lives. All of these factors reduce the confounding variables--such as poverty and lack of health care--that can cloud the meaning of data. Outside a laboratory, it would be hard to find as pure an environment for research.

In fact, I went on, nuns had already played a crucial role in expanding our understanding of two devastating diseases that afflict women: breast cancer and cervical cancer. In the 1950s scientists observed that nuns had an unusually high risk for breast cancer. This led researchers to examine overall breast cancer rates more closely, comparing single to married women. It emerged that single women, like nuns, also had a high risk of breast cancer. The variable turned out to be pregnancy and the hormonal changes it causes. Much of today's understanding of how hormones affect breast health had its origin in this research.

Several famous studies, on the other hand, have reported cervical cancer to be rare in nuns and common in prostitutes, I offered, immediately realizing how odd this must have sounded to Sister Carmen. In this case, it was a sexually transmitted virus that ultimately emerged as the link to cancer. "Again, it isn't difficult to make the connection," I added.

"No, it isn't," she agreed.

I gladly changed the subject to aging and the purpose of my visit. "I'm hoping the study of the School Sisters of Notre Dame will lead to some major clues about aging and disease," I said. "Ultimately, I want to increase our knowledge and help people live longer, better lives."

Sister Carmen brightened when she heard this. If she was bothered by the vagueness--or vastness--of what I was proposing, she didn't let on. She sat quietly for a minute.

"Let me tell you, Dr. Snowdon," she began. "We have always believed in the power of knowledge and ideas. A large part of our mission has always been teaching. Over ninety percent of our sisters have been teachers at one time. Some of our older sisters taught in towns that had no schools before they arrived.

"Our sisters have spent their entire adult lives trying to help other people in the community. Even in their retirement, they have a deep passion and drive to help others. I think they would see your study as a way to continue their lifelong mission of helping others, of educating others."

"Yes, I hope so," I said.

Sister Carmen paused again and then let out a big, contented sigh. "Okay," she said, as only a Minnesotan can.

"Okay?" I was confused. "You mean--"

"Wait." She raised her open hand and stopped me in midsentence. "I'll move forward with your request, but you need to listen carefully to what I am about to say. No matter what you do, I want you to remember who these women are. They are real people. Very dear to us. They are holy people, too. I don't want you to treat them as research subjects. Get to know them. Understand that many of the older sisters were the teachers or mentors of the younger sisters, and we treat them with the care and respect they deserve. We will expect nothing less from you."

I was a little stunned by Sister Carmen's statement. My prior research projects had included tens of thousands of participants, and I knew them only through their medical records and the questionnaires they had filled out. All researchers are taught that scientific objectivity depends on keeping one's distance from the people one studies. I had no idea how I could fulfill her request, so I simply nodded and said, "I'll do my best."

Sister Carmen gave me this parting advice: "They will open up to you," she said, "but only if you give of yourself first."

If Sister Carmen had asked me how I became an epidemiologist, I would have had to answer, "Chickens."

Puberty took away my lithe frame, ruining my imagined future as a gymnast, so I needed something new to do after school. Unlike my two older brothers, I had little interest in football or baseball. Being a teen also meant that I badly wanted to be different from my brothers--and everyone else. So I decided to take up a hobby my father had pursued when he was a child: raising chickens and selling their eggs. With his help, I built a couple of coops in our suburban backyard and bought some multicolored bantam chickens at a local farm.

Bantams are the most petite breed of poultry, and they only occasionally lay eggs, which also are quite small. When I realized that these miniature chickens would produce only miniature profits, I began to do my homework. I became a student of chickens.

I read every book in the library about chickens, requested every pamphlet on chicken farming available from the United States Department of Agriculture, and wrote every hatchery in the state asking for information on their chicks. I finally decided to breed Rhode Island Reds, which my father had raised, both because they had excellent egg production and because they had enough meat on their bones to make a decent meal. I bought a trio of Reds, two hens and a rooster, from a noted breeder in Illinois, who shipped them by train to my home in California.

My chicken hobby became my passion. Business began to boom, and I made more money on my egg route than my friends made on their newspaper routes. I became "David the Eggman," a nickname that riffed off Beatles lyrics and made me proud.

My flock grew to nearly a hundred Rhode Island Reds, and I monitored my population closely. I weighed each bird weekly and charted individual egg production. I vaccinated every chick. Any bird that fell ill went into isolation so as not to infect others. I installed the best watering system I could afford, fed them high-quality feed, kept refining their housing conditions, and when necessary treated them with antibiotics. It was pure economics: The longer I could keep each bird alive, well, and productive, the more money I could make. I began systematically studying ways to maintain my flock's health and well-being, which led to several blue-ribbon birds that I showed at the San Bernardino County Fair.

Although I did not know it at the time, my chickens taught me the fundamentals of epidemiology. Understanding the causes of a disease in a population can lead to prevention strategies--and it's far more effective to prevent disease than to treat it after it has occurred. To study the factors that cause disease, we need to compare individuals in a population, from the direly ill to the remarkably healthy as well as the ones in between. Disease is a process, and the conditions of early life--whether chosen or imposed--often cause or prevent later problems.

Finally, my flock also introduced me to a central focus of gerontology: the importance of maintaining function and of understanding the key points along a continuum, from highly productive to completely disabled. For my chickens, the question was pretty simple: How often and long would they continue to lay eggs? Successful aging in a human being is more complicated, as maintaining both physical and mental function requires an intricate interplay of myriad factors. Nonetheless, the basic principles are similar to those I learned in my own backyard.

I've always enjoyed the two-hour drive down U.S. 169 from the Twin Cities to Mankato. I made the trip for the first time two weeks after my meeting with Sister Carmen Burg. The road keeps company with the Minnesota River much of the way and runs through rolling fields of soybeans and corn. Elm trees shade the white farmhouses, and silos sit next to red barns--the kind of comfortable midwestern landscape that might appear in a child's picture book. It was a six-day trek in 1852, the year Mankato was named with the Sioux word for "blue earth." The bluish-tinted clay soil is still visible along the roadside as you approach the town. The French explorer Pierre LeSueur was so sure it contained copper that he shipped two tons of the stuff back to France in 1701--only to be given the disappointing news that it was worthless.

Good Counsel Hill--or the Hill, as it is known in these parts--is in the northern section of town. As the road winds upward past the high school track and soccer field, the spire of the convent's chapel jumps into view. The aqua-colored water tower confirms that you are in the right place: Good Counsel, it says in bold block letters.

Past a garden planted with azaleas, roses, and wildflowers, the convent's main entrance is guarded by two marble angels. I still miss the presence of Sister Timona, who was the unofficial night sentry during my early visits. Sister Timona maintained her post in full black-and-white habit, resting from time to time in one of the wheelchairs kept by the door. This was her only concession to her eighty-nine years of age. She would call out cheerfully to the nurses at shift change, and she soon greeted me just as warmly.

The convent is made up of four no-frills red brick buildings, and the hallways can sometimes feel like a maze. But the feeling of orderliness and calm is palpable the minute you enter. To the left of the main entrance is the community room, lit by high windows and furnished with comfortable sofas and rockers. Brass lamps and green plants sit on the side tables, along with copies of Catholic Digest and Time and glass jars of peppermints.

There's a large dining table at one end of the room, and next to it is a smaller table where a few sisters--the "night owls"--sometimes play cards late in the evening, which means eight-thirty or nine, except for Fridays, when the sisters stay up a little later for popcorn and pop. The sisters are big on games. Competition is stiff on everything from dominoes to Triple Yahtzee, bridge to Scrabble, Boggle to cribbage, and a dice game called Fill or Bust. I learned quickly that I'd have to pay full attention if I wanted to keep up with the play--and the scoring.
David Snowdon|Author Q&A

About David Snowdon

David Snowdon - Aging with Grace
Epidemiologist David Snowdon is one of the world's foremost experts on Alzheimer's disease, due in part to the unique focus of his research. In Aging With Grace he presents the fascinating data and compassionate human stories on the aging nuns he studied for many years.

Author Q&A

An Interview with Dr. David Snowdon

Since 1986, Dr. David Snowdon has led a scientific team that is profoundly changing the way we view aging. Early results of "The Nun Study," as it is known, have made headlines internationally and been featured in Time, National Geographic, Newsweek, and on Nightline, CNN and the CBS Evening News, as well as in leading scientific journals. Just as extraordinary as the research reports is the human story of the hundreds of Roman Catholic sisters, ranging in age from 75 to 106, who have allowed Dr. Snowdon access to their medical and personal records -- and who have agreed to donate their brains upon death. We interviewed Dr. Snowdon about his new book, Aging With Grace: What the Nun Study Teaches Us About Leading Longer, Healthier, and More Meaningful Lives.

What makes the Nun Study unique?

Before I started the Nun Study, I'd done research involving tens of thousands of participants with data drawn from questionnaires. When I first sought permission to work with the School Sisters of Notre Dame, a leader of the congregation, Sister Carmen Burg, said yes on one condition. She insisted that that I treat the sisters as human beings, not as research subjects -- she told me to go to the convents and get to know them as individuals. This, of course, flies in the face of the way scientists are trained in the name of "objectivity." But what a gift! I now have honorary great-nephew status with a group of remarkable women.

What makes them remarkable?

The School Sisters of Notre Dame were founded in Germany with a special mission to serve poor girls in rural areas. In this country, they followed the settlers west and played a great role in the expansion of educational opportunity. Almost all of the sisters were lifelong teachers. Some of the oldest nuns taught in communities that had no schools before they came. Of the sisters in our study, about 85 percent had bachelor's degrees, and 45 percent had master's degrees -- amazing figures for women of any generation.

Is your book about the sisters or about the science?

Both. I try to take readers inside the process of how we've made our discoveries -- like all real science, it has many twists and turns and surprises. But as I've learned, you can't understand aging and Alzheimer's disease without seeing how they affect real human beings. One of my closest friends among the sisters -- I call her Sister Maria in the book -- died of Alzheimer's disease. You could see aspects of her beautiful personality right up until the end. And the well sisters give extraordinary support to those who are failing -- they don't lose sight of their humanity. That's an important message I'd like people to take from the book.

You are an epidemiologist. What perspective does that give you on Alzheimer's disease?

Epidemiologists are trained to search out the causes of diseases in large groups, often over long periods of time. Nuns are an ideal group to study because they live such similar lives -- it is easier to home in on the differences that really count. Because of this, the Nun Study has been able to discover that the most common form of Alzheimer's is not a yes/no disease that suddenly occurs as we get older. It actually appears to have roots in early life, and there are many lifestyle factors, including education, nutrition, exercise, depression, and cardiovascular health, that seem to play a role in its development.

Wasn't it difficult to ask the sisters to donate their brains?

It's probably the hardest thing I've ever done. The brain is not just another organ. Most of us feel that it contains our identity -- our mental, emotional and spiritual history. That makes the sisters' response all the more amazing -- 66 percent of those who were eligible joined the Nun Study. (Based on other studies, we thought we'd be lucky to get 20 percent.) I'll never forget what Sister Rita Schwalbe, one of the convent leaders, told me: "Our congregation was founded to work with the poor and powerless. Who's more powerless than someone with Alzheimer's disease?"

What happens to the sisters' brains after they die?

They are brought to our lab at the Sanders-Brown Center on Aging at the University of Kentucky, where they are analyzed to determine the extent and location of the characteristic damage of Alzheimer's disease -- the so-called "plaques and tangles" that kill neurons and disrupt communication within the brain. This information is then matched with the mental and physical tests we have conducted on the sisters while they were alive. This has resulted in some real surprises.

Such as?

We have discovered sisters with the most extensive form of Alzheimer's damage in their brains who performed brilliantly on our mental tests. We have discovered that a sister may be severely demented without having significant brain damage. In other words, the symptoms don't always match the pathology. This astounded Dr. William Markesbery, the neuropathologist for the Nun Study. We have also discovered that the cumulative brain damage done by small strokes may tip the balance toward dementia. Ultimately, this is good news, because we do know how to prevent strokes. Another piece of good news: some of the healthiest brains we have found are in centenarians. Even if we become extremely old, decline is not inevitable.

Haven't you also shown that the sisters have remarkable longevity? How do you account for this?

The risk of death in any given year after age sixty-five is about 25 percent lower for the School Sisters of Notre Dame than it is for the general population of women in the United States. This means that the sisters live dramatically longer lives than their lay counterparts. At one point, in one convent alone, there were seven living centenarians -- the sisters called them The Magnificent Seven. Certainly education and a prudent, healthy lifestyle play an important role -- for example, none of the sisters smoke. But I believe that intangibles such as positive life purpose, spirituality, and a supportive community are also significant.

Based on your findings, is there anything we can do to prevent Alzheimer's? For instance, some people say we should avoid aluminum in soda cans or cookware.

That aluminum story just won't die -- but it has never been proven, and most scientists today discount it. The Nun Study has also shown that another suspect -- the mercury in dental fillings -- is not a factor. In my public talks, I stress doing everything we can to prevent strokes -- and to treat them immediately if one occurs. We've all heard this message before: Keep your weight and blood pressure down. Exercise. Quit smoking. But if you know these steps can also help prevent the symptoms of Alzheimer's, you're more likely to pay attention.

If a person has a family history of Alzheimer's, can they take a genetic test for the disease?

When I'm asked this, I often reply, "What difference would it make if you knew?" Many people overestimate the power of genes. The early-onset form of Alzheimer's, which emerges in people before age 65, does seem to be strongly genetically determined, but it accounts for only 5 to 10 percent of cases. There is also a gene associated with late-onset Alzheimer's, but many people who get Alzheimer's do not carry it. We will probably discover more genes in the future -- and also more ways that they interact with things we can control.

Are there any foods or supplements that can help ward off Alzheimer's?

I did my Ph.D. research on nutrition, and I would love to be able to come up with a definitive answer -- but we don't have one yet. The best evidence right now points to the protective effect of antioxidants -- like vitamins C and E. High levels of folic acid are also emerging as an important factor in brain health throughout life. But it may be more important to eat many fruits and vegetables than to load up on supplements. I currently take about one and a half times the standard daily value for vitamins -- and most of my colleagues also avoid megadoses. Finally, I think that some so-called alternatives, such as gingko biloba, show promise. But we need much more research in this area.

You've made some remarkable claims about the autobiographies the sisters wrote when they entered the convent. Why did you study these?

The autobiographies are one- or two-page documents written when the sisters were in their early 20s, before they took their religious vows. When we first discovered them in the convent archives, it was as if we had opened a fascinating time capsule. We have since discovered that they have amazing predictive power. For example, a linguistic measure called idea density predicted who would get Alzheimer's -- 60 or more years later -- with 80 percent accuracy. The sisters who packed the most ideas into their sentences at age 22 were somehow protected at age 85! We still don't know exactly what brain mechanism is involved, but other research has shown that Alzheimer's may be a lifelong process. Another Nun Study paper, which will be published this May, links longevity to emotional expression in the autobiographies. We discovered that the sisters who expressed the most positive emotions in their writing lived years longer on average than those who expressed the least. Maintaining a positive attitude appears to be very important to living a long and healthy life.

What's next for the Nun Study?

Right now, we believe that we will be collecting data for another twenty years. As of the start of 2001, 295 of the original 678 participants were still alive. The youngest was 84 and the oldest was 106. And as we continue to develop new hypotheses, we go back to study the brains we have already collected, all of which are carefully preserved. We want to clarify the dividing line between Alzheimer's and what is called mild cognitive impairment. We are developing more sophisticated ways to evaluate the living brain, so we can improve early detection and diagnosis. We will do more gene screening, and also continue our research on emotion and personality.

Has the Nun Study changed your own attitudes towards aging?

Well, I turn fifty next year, and I'm much more optimistic now than when I was younger. I've known a number of centenarian sisters who are still active and enjoying life. They've made a good old age seem like a real possibility.

From the Hardcover edition.



“Startling, often encouraging discoveries.”
USA Today

“A moving, intensely personal account.”

“A wonderfully provocative account of how women age and thrive.”

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