Can Dementia Be Prevented?

Let's start with the good news. Among Americans, only one out of eight develop any form of dementia by the age of 65. By 80, four out of seven are still dementia free. Nevertheless, dementia and the related cognitive impairment and short term memory loss, can be devastating to both the person who suffers from it as well as to friends and loved ones.

When I speak of dementia, I mean all types of dementia, including the most common called Alzheimer's and the second most common called vascular or multi-infarct dementia. For a good video review of the the entire topic of dementia and it's prevention based on lifestyle changes, please see my five-part youtube video lecture that starts at http://www.youtube.com/watch?v=nAXJFVDO5-8.

Since giving this lecture back in 2011, the preponderance of evidence I have come across supports the relationship between lifestyle and the development of dementia  However, there were two recent studies worthy of careful consideration. The first, which I wrote about in my blog titled "If You Jump Up and Down After Reading Today's Blog, You May Actually Remember It When You Get Older!,"which can be found at http://mdprevent.blogspot.com/2013/02/if-you-jump-up-and-down-after-reading.html, identifies the correlation between physical fitness and dementia prevention. Exercise is undoubtedly the number one best known strategy to delay or prevent the onset of cognitive impairment. It's better than intellectual stimulation and all the drugs and supplements on the market today. Move!

What about diet? Well, a new study just came out, prompting today's blog that demonstrates the relationship between what you eat and what develops in your cerobro-spinal fluid (CSF), the fluid that encases the brain and spinal canal.  In this study, people fed a low fat, low carb diet were found to have the lowest levels of beta-amyloid, a peptide (smaller than protein) most scientists believe (some believe it's a protein called tau and others think it may be something else entirely) is responsible for the development of Alzheimer's. Although this study was not conducted long enough to offer definitive evidence that a diet that decreases levels of beta-amyloid in the CSF results in lower rates of dementia, I think it still merits close attention because it supports the strengthening assertion that what you eat affects the long term health of not only the rest of your body, but your brain as well.

With the preponderance of evidence showing that what you eat has a profound impact on your chances of living a longer, healthier, pain-free life, or dying prematurely from cancer, heart disease, etc, isn't it seriously worth rethinking the foods you eat?

The short list remains the same. Avoid processed sugar based products, saturated fats, and trans fats, and consume plenty of vegetables, fruits, nuts, beans, seeds, whole grains, and wild Alaskan Salmon.

If You Jump Up and Down After Reading Today's Blog, You May Actually Remember It When You Get Older!

It won't come as news to anyone that exercise helps you stay fit and being fit is good for your health. It also probably won't come as a surprise that being fit is good for your mood. But what about memory? Will exercise preserve memory? Does being fit earlier in life affect what happens many years later? Will being fit prevent Alzheimer's and other forms of dementia?

Until now, scientists have had strong suspicions that lifestyle plays a meaningful role in preserving healthy brain function, but they didn't know for sure. A new study just came along that moves the needle along in validating the key role that exercise plays in prevention.

Published in the February 5, 2013 issue of the Annals of Internal Medicine, the study titled "The Association Between Midlife Cardiorespiratory Fitness Levels and Later Life Dementia" was a cohort study that does not prove cause and effect but deserves close attention. The study performed at The Cooper Institute in Dallas Texas involved 19, 458 middle aged people who had a treadmill exercise test as part of health care preventive visit. Based on the amount of time that a person was able to run on the treadmill, researchers grouped them into two categories of most fit and least fit. They then followed these people for many years, beyond the time they reached 65 years, to see who developed dementia.

What did they find? You guessed it. The people in the most fit group were far less likely to develop dementia. Although the study did not look at diet, which is obviously an important contributing factor to health, and was limited to mostly healthy white people, it does offer possible evidence of an association between fitness and memory preservation.  Again, the study did not prove cause and effect but it does provide yet another reason to stay fit by being physically active.


While only 1 out of 8 Americans develop dementia by the age of 65, that number rises to 3 out of 7 by age 85. Although that represents less than half of those over the age of 85, no one, but the most cynical, would disagree that it would be better to avoid dementia than experience it.  It's no fun to lose your memory. Just ask anyone who suffers from a form of dementia or watched a loved one die from it. The good news is that science suggests that if you get to age 90 without developing dementia, the probability of development appears to decrease due to possible suppression of the gene responsible for it.

So if you are sitting down when you read this, it may be a good idea to get off your seat and jump up and down.  If you keep doing that long enough and as often as possible, you may remember this blog for many years to come. That would be nice, right?

Nu? So what are you waiting for? Get up and get moving! Now, before you forget how important it is to your future memory...

Can We Prevent Aging? National Institute of Aging Speaks

On Sunday, I wrote that I would soon discuss reseveratrol. Resveratrol was one of the products that Dr. Oz had inappropriately touted last week as an anti-aging dietary supplement.

Here’s an excerpt from his website about resveratrol:

“You can further protect your body from the harmful effects of inflammation by taking a resveratrol supplement. Resveratrol is a compound found in plants such as the Japanese knotweed, blueberries, peanuts, red grape skins, and others. While resveratrol has been recommended for fighting the physical effects of aging, a brand new study shows it reduced inflammation of the heart in the study's participants by 26%. Taking one 500 mg capsule of resveratrol daily with food will help you maintain a strong, healthy heart.”

By the way, after an hour of searching, I can find no reference to any human “brand new study” regarding resveratrol. In fact, if you examine his words carefully, he doesn’t refer to humans. He only refers to ”participants.” How misleading is that?

After initiating my research into the facts about resveratrol, yesterday, I received a publication from the National Institute of Aging, part of the National Institutes of Health, titled ‘Can We Prevent Aging?’

 

This publication offers a succinct review of all the current “anti-aging regiments available to us beyond a healthy lifestyle. It’s a fairly long publication, so I’ve taken the liberty to excerpt certain key sections under headings that I think would be helpful to my patients.

The headings include:

Antioxidants

Resveratrol

Hormone Therapy and “'Anti-Aging' Supplements”

Hormone Replacement Therapy

Testosterone

Bioidentical Hormone Therapy

Dehydroepiandrosterone, or DHEA

If you read anything I’ve sent you, read this. It’s an excellent up to date summary of the science regarding a number of popular, but unproven methods to decrease or reverse aging. For those of you who don’t have the time or inclination to read it, here’s the National Institute of Aging’s summary:

Until more is known about antioxidants, resveratrol, and hormone supplements, consumers should view these types of supplements with a good deal of caution and doubt. Despite what advertisements on television, the internet, and magazines may claim, there are no specific therapies proven to prevent aging. Some harmful side effects already have been discovered; additional research may uncover others.

On Antioxidants:

Antioxidants protect the body from the harmful effects of by-products known as free radicals, made normally when the body changes oxygen and food into energy. The discovery of antioxidants raised hopes that people could slow aging simply by adding them to the diet. So far, studies of antioxidant-laden foods and supplements in humans have yielded little support for this conclusion. Further research, including large-scale epidemiological studies, might clarify whether dietary antioxidants can help people live longer, healthier lives. For now, although the effectiveness of dietary antioxidant supplementation remains controversial, there is positive evidence for the health benefits of fruits and vegetables.

On Resveratrol:

In one study, scientists compared two groups of overweight mice on a high-fat diet. One group was given a high dose of resveratrol together with the high-fat diet. The overweight mice receiving resveratrol were healthier and lived longer than the overweight mice that did not get resveratrol. In a follow-up study, researchers found that, when started at middle age, resveratrol slowed age-related deterioration and functional decline of mice on a standard diet, but did not increase longevity. A recent study in humans reported that resveratrol may have some similar health benefits to those in animals; however, it is still too early to make any definitive conclusions about how resveratrol affects human health and aging. More research is needed before scientists know if there is a proper and safe dose of resveratrol or if it has any clinical applicability in people.

 

On Hormone Therapy and “'Anti-Aging' Supplements”:

Higher concentrations of hormones in your body are not necessarily better. And, a decrease in hormone concentration with age is not necessarily a bad thing. The body maintains a delicate balance between how much hormone it produces and how much it needs to function properly. Natural hormone production fluctuates throughout the day. That means that the amount of hormone in your blood when you wake up may be different 2, 12, or 20 hours later.

If you take hormone supplements, especially without medical supervision, you can adversely affect this tightly controlled, regulated system. Replacement or supplemental hormones cannot replicate your body’s natural variation. Because hormonal balance is so intricate, too much of a hormone in your system may actually cause the opposite of the intended effect. For example, taking a hormone supplement can cause your own hormone regulation to stop working. Or, your body may process the supplements differently than the naturally produced hormone, causing an alternate, undesired effect. It is also possible that a supplement could amplify negative side effects of the hormone naturally produced by the body. At this point, scientists do not know all the consequences.

Some hormone-like products are sold over the counter without a prescription. Using them can be dangerous. Products that are marketed as dietary supplements are not approved or regulated by the FDA. That is, companies making dietary supplements do not need to provide any proof that their products are safe and effective before selling them. There is no guarantee that the “recommended” dosage is safe, that the same amount of active ingredients is in every bottle, or that the substance is what the company claims. What you bought over the counter may not have been thoroughly studied, and potential negative side effects may not be understood or defined. In addition, these over-the-counter products may interfere with your other medications. NIA does not recommend taking any supplement touted as an “anti-aging” remedy because there is no proof of effectiveness and the health risks of short- and long-term use are largely unknown.”

On Hormone Replacement Therapy:
Here’s what scientists know:

• Endometrial problems—While estrogen helps some women with symptom management during and after menopause, it can raise the risk of certain problems. Estrogen may cause a thickening of the lining of the uterus (endometrium) and increase the risk of endometrial cancer. To lessen these risks, doctors now prescribe progesterone or a progestin, in combination with estrogen, to women with a uterus to protect the lining.
• Heart disease—The role of estrogen in heart disease is complex. Early studies suggested MHT could lower postmenopausal women’s risk for heart disease—the number one killer of women in the United States. But results from the NIH Women’s Health Initiative (WHI) suggest that using estrogen with or without a progestin after menopause does not protect women from heart disease and may even increase their risk.

In 2002, WHI scientists reported that using estrogen plus progestin actually elevates some postmenopausal women’s chance of developing heart disease, stroke, blood clots, and breast cancer, but women also experienced fewer hip fractures and cases of colorectal cancer. In 2004, WHI scientists published another report, this time on postmenopausal women who used estrogen alone, which had some similar findings: women had an increased risk of stroke and blood clots, but fewer hip fractures. Then, in 2007, a closer analysis of the WHI results indicated that younger women, ages 50 to 59 at the start of the trial, who used estrogen alone, had significantly less calcified plaque in their coronary arteries than women not using estrogen. Increased plaque in coronary arteries is a risk factor for heart attacks. Scientists also noted that the risk of heart attack increased in women who started MHT more than 10 years after menopause (especially if these women had menopausal symptoms). There was no evidence of increased risk of heart attack in women who began MHT within 10 years of going through menopause.

• Dementia—Some observational studies have suggested that estrogen may protect against Alzheimer’s disease. However, testing in clinical trials in older, postmenopausal women has challenged that view. In 2003, researchers leading the WHI Memory Study (WHIMS), a substudy of the WHI, reported that women age 65 and older who took one kind of estrogen combined with progestin were at twice the risk for developing dementia compared to women who did not take any hormones. In 2004, WHIMS scientists reported that using the same kind of estrogen alone also increased the risk of developing dementia in women age 65 and older compared to women not taking any hormones. What possibly accounts for the different findings between the observational and clinical studies? One central issue may be timing. The women in the WHIMS trial started treatment a decade or more after menopause. In observational studies that reported estrogen’s positive effects on cognition, the majority of women began treatment soon after menopause. This has led researchers to wonder if it may be advantageous to begin treatment earlier, at a time closer to menopause. Additionally, it appears that progesterone and progestins (progesterone-like compounds) differ in their impact on brain health.

Despite research thus far, there are still many unknowns about the risks and benefits of MHT. For instance, because women in their early 50’s were only a small part of the WHI, scientists do not yet know if certain risks are applicable to younger women who use estrogen to relieve their symptoms during the menopausal transition.

 

On Testosterone:

“The bottom line: there is no scientific proof that testosterone treatment in healthy men will help them age better. Until more scientifically rigorous studies are conducted, it is not known if the possible benefits of testosterone therapy outweigh any of its potential risks. NIA continues to conduct research to gather more evidence about the effects of testosterone treatment in aging men.”

On Bioidentical Hormone Therapy:

“Large clinical trials of these compounded hormones have not been done, and many bioidentical hormones that are available without a prescription are not regulated or approved for safety and efficacy by the FDA.”

On Dehydroepiandrosterone, or DHEA:

“[S]ome proponents claim that over-the-counter DHEA supplements can improve energy and strength and boost immunity. Claims are also made that supplements increase muscle and decrease fat. To date, there is no conclusive scientific evidence that DHEA supplements have any of these benefits.
The conversion of naturally produced DHEA into estrogen and testosterone is highly individualized. There is no way to predict who will make more or less of these hormones. Having an excess of testosterone or estrogen in your body could be risky.
Scientists do not yet know the effects of long-term (defined as over 1 year) use of DHEA supplements. Early indications are that these supplements, even when taken briefly, may have detrimental effects on the body, including liver damage.”
“Researchers are working to find more definite answers about DHEA’s effects on aging, muscles, and the immune system. In the meantime, if you are thinking about taking DHEA supplements, be aware that the effects are not fully known and might turn out to cause more harm than good.”



Conclusion:
Until more is known about antioxidants, resveratrol, and hormone supplements, consumers should view these types of supplements with a good deal of caution and doubt. Despite what advertisements on television, the internet, and magazines may claim, there are no specific therapies proven to prevent aging. Some harmful side effects already have been discovered; additional research may uncover others.

I  hope this information has been helpful and as always, please feel free to share your comments.

Why We Live Longer Is More Important Than How Long We Live

I recently came across an article written by Michael Wolff that appeared in New York Magazine titled, "Mom, I Love You. I Also Wish You Were Dead. And I Expect You Do, Too." The gist of the article is that there is no good reason to live longer. The author paints a picture that living longer means a more painful, slow death.

It is a frightful article written by someone who is clearly in pain watching his mother suffer from a terminable illness. However, it is also just plain wrong. The fact that the author makes statements with reckless abandonment may be forgiven given his state of mind. But, I don't believe for one moment that what he has to say is true in most cases of extended longevity.  Why? Because the scientific facts speak otherwise.

A recent study from the Longevity Genes Project, launched by the Albert Einstein College of Medicine in New York City, supports my assertion. The results of the study, focused on near-centenarians, showed that the majority of  them were found to be "relaxed, friendly, conscientious and upbeat about life." Importantly, added the authors, "an easy laugh and an active social life were observed to be a group norm, while neuroticism was notably the exception. What's more, feelings were more commonly shared as they arose, rather than stifled and squelched." Not quite the doom and gloom reported by Mr. Wolff.

Mr. Wolff would have his readers believe that dementia strikes virtually everyone as we age. In fact, less than 50% of Americans over 85 develop dementia and about a quarter of all dementias are now directly linked to lifestyle, and thereby, may be preventable. What I think was missed by Michael is that why you live longer is as important as what that life looks like.

If you live longer only due to the miracles of modern science and technology, such a life may not be worth living. The goal is not to be alive at any cost, strapped to money machines that ka-ching with every passing moment. The reason to live longer is to enjoy more healthy years of life free of disability and pain.

A second recent study, that helps confirm healthy living can extend life even in the retirement years, demonstrates how to achieve such a life.  Led by Emily Nicklett, an assistant professor of social work at the University of Michigan School of Social Work, in Ann Arbor, the study, which was designed to explore the impact of exercise and nutrition together, found that women who were both the most physically active and the highest consumers of fruits and vegetables were eight times more likely to be alive after the study's five years of follow-up, compared to women who scored lowest on both counts.


There you have it. By living a healthy lifestyle, the women in the Michigan study avoided premature death and reported living quality lives. It's not surprising because exercise and good nutrition have been shown repeatedly to keep depression, dementia, falls, cancer, diabetes, heart disease, and stroke at bay for long periods of time.

The bottom line is we all eventually die and how we die is often unpredictable. But living a healthy lifestyle increases the probability of enjoying more good years. Michael Wolff ultimately misses the real point. If his mother had taken ill a number of years earlier, would the situation have been any less poignant and painful? Watching a parent suffer at any age is difficult for most children. Having a few more good years with the parent(s) before the process begins is a gift.

So if you want to live a longer, functional, and disease-free life, a word to the wise should be sufficient. Learn how to eat properly and get enough exercise to remain in good form and fitness. Michael Wolff may long for his mother's passing, but I long to keep my patients healthy and enjoying life for many more years because it beats the alternative.

Prevention May Be The Best Path

Did you hear the good news? Yesterday, researchers at Duke University using a new model, predicted that by 2030, only 42% of Americans will be obese. Today that number is 36%, but the apparent good news is that a previous model predicted it would be 51%.  At the same time, the researchers predict that severe obesity would rise to 11% instead of the previously predicted 9%. 

The reasons for the discrepancy were described as the researchers taking into account factors such as unemployment rates; prices for alcohol, gas, and fast food; prices of healthy versus unhealthy foods; access to the Internet; and the number of fast-food and full-service restaurants per 10,000 people.

So is this really good news? Should we break out the champagne or the tissues? I find it hard to imagine that nearly half of all Americans will be considered obese in less than twenty years. But what is even more difficult to absorb is that our government is not obsessing about this problem.

This year, the Centers for Medicare and Medicaid Services (CMS) took a big step forward and initiated coverage of Intensive Behavioral Therapy for Obesity. They define obesity as a body mass index (BMI) of 30, which is about a 5 foot 4 inch woman weighing about 170 pounds or a 5 foot 9 man weighing about 200 pounds.  The problem is that if your BMI is 29.9, you are out of luck. At that number, you are entitled to no therapy whatsoever.

I can appreciate that there needs to be a threshold at some level, but I believe it should be several BMI points lower. Why wait until someone is already obese to intervene? Studies show that many things change including our gut bacteria, metabolism, and hormonal balances as we gain weight. Basically, it gets harder to lose weight the more you gain AND it gets harder to keep it off after we gain it and try to lose it again.

The other problem with CMS's obesity initiative is that the reimbursement is approximately $27 for 15 minutes up to 16 times spread across 6 months (6 more spread across the next 6 months if you lose 6.6 pounds after the first 6 months). That extrapolates to about $108 per hour, far below what the average primary care physician, which is the only type of physician that can offer the service, earns before overhead, staff, malpractice insurance, billing costs, etc.

Multiple google searches have failed to identify a single doctor or practice in the U.S. offering this service. I can find no practice marketing it. I also asked dozens of primary care providers and they have said they do not as well.

Is it the low reimbursement? Maybe. Is it the lack of knowledge necessary to provide intensive behavioral therapy? Maybe? Is it the reluctance of doctors to tackle their patients' obesity?  I can only say maybe again because I don't really know any of these answers as to why other doctors choose as they do. But I do know we have a problem and it's not just doctor engagement.

I think the real problem is the patients.  Tackling obesity with just primary care practitioner led therapy, instead of pills and surgery, requires real commitment on the part of patients. Obese patients know they have a health problem and that their long term health prospects are at play. Most also know that obesity is not particularly attractive. Yet, whether you believe it is a disease or a choice, these same people find it difficult to tackle their issue. Few prefer to be so overweight and need help to break out of their weight captivity.

So what do we do about this problem? Some may say financial incentives. I don't think that is a long term solution and I have previously explained why. While short-term incentives may work, weight is often easily regained unless fundamental changes to lifestyle are made and such changes can most of the time only be brought about by a concerted effort.

So how do we do that? I propose an integrated and interdisciplinary approach. In other words, I think it will take a team effort of motivated, committed, and trained practitioners to support, guide and educate patients to bring about real change. About 4 months ago, MDPrevent proposed such a model to CMS. MDPrevent asked for funds, to which I and others would contribute additional funds, to tackle not only the rising epidemic of obesity, but also heart disease, diabetes, dementia, and cancer.

MDPrevent's program, which we titled, Intensive and Integrated Behavioral Therapy for Lifestyle Modification would combine the talents of a primary care provider, a registered dietitian, a health psychologist, a fitness instructor, and a health educator to work with patients on both an individual and group (group success can be contagious) basis and help them tap into their own motivation to make change.

We anticipated that it would take a full year to bring about meaningful success and expected to be able to do so at a cost of slightly above $600 per patient. For this meager amount, we believe that we can change the course of someone's health and life trajectory.

Can anyone argue that it isn't worth the effort given the obesity and other chronic disease projectories? There is no profit for MDPrevent in the amounts requested because we believe that we must first prove the success of such a program before profits can even be considered.

The goal of the program is to identify and tackle pre-obesity, pre-diabetes, pre-stroke, pre-heart attack, and pre-cancer situations and implement a series of lifestyle changes to prevent, delay or even mitigate the development of these life threatening conditions.

The decision from CMS regarding funding this initiative was originally due March 30. We are in overtime. I am told it will come shortly. This program could be a game-changer for the country at large. Wish us luck!

Longevity and Weight: What's the connection?

For the past year, I have been meeting with, treating, and lecturing to over a thousand seniors. Although this is not a scientific conclusion, I notice that people in their late 80s and above are never markedly overweight and those who are markedly overweight often look older than they are. This is consistent with a study of Jews of Eastern European descent that are believed to have a longevity gene that confers the potential to live into their 90s and above. The study showed that despite sometimes living unhealthy lifestyles, none of those living into their 90s were overweight.

A study reported today further supports this conclusion.

First, let's review what is the Body Mass Index (BMI).  BMI is a measurement of weight classification calculated by factoring in your weight and height. It is an imperfect measurement because it doesn't differentiate between high body fat and muscle content. BMI has been used by the World Health Organization as the standard for recording obesity statistics since the early 1980s. (The formula is pasted at the end of the blog.) Here in the U.S., it is also the most commonly used measurement to determine underweight, normal weight, overweight, and obesity.

Generally a BMI below 18.5 is considered underweight, 18.5-25 is considered normal, above 25 to 30 is overweight, 30 to 35 moderately obese, 35 to 40 severely obese, and above 40 very severely or morbidly obese.  (It is used differently for children but I won't discuss that here. Write me for more information.)

In a new study,  Nicholas J. Timpson, PhD, of the University of Bristol, in England, and colleagues found that for every .8 (point eight)  increase in BMI, ischemic heart disease risk rose 52%.

 "These data add evidence to support a causal link between increased BMI and ischemic heart disease risk, though the mechanism may ultimately be through intermediate factors like hypertension, dyslipidemia, and type 2 diabetes," the group wrote in the May issue of PLoS Medicine."

Furthermore, they explained that "Observational studies, both prospective and retrospective, consistently link higher BMI to heart risks across different populations, but haven't convincingly demonstrated causality because of the possibility of confounding, reverse causation, and bias."


Everyone knows that being overweight is often associated with developing chronic diseases like heart disease, diabetes, stroke, cancer and dementia. However, this study is a big deal because it shows a direct correlation between weight and heart disease risks.

So it turns out that what I have been noting empirically, is in fact, scientifically grounded. The heavier you are over a BMI of 25 the more likely you are to die prematurely from ischemic heart disease, and I suspect, from other diseases as well.

At a health fair on Monday, I greeted passersbys with "How would you like to add more healthy years to your life?"  I thought this question will receive a resounding yes every time asked and it would allow me to engage the person in a meaningful conversation regarding the benefits of taking advantage of Medicare's smorgasbord of wellness and preventive services. I was wrong.

At least a quarter of the people said they were not interested. Perhaps it was my delivery or they were wary of what I was offering as too good to be true.  I really don't know the reason, but it amazed me anyway that anyone could answer that question negatively. I shouldn't be surprised.  Since the introduction of new wellness and preventive benefits in January 2011, less than 94% of eligible seniors nationwide have taken advantage of over $1,000 worth of these life-enhancing benefits. These services were implemented by Medicare to help seniors avoid chronic disease, prevent heart attacks, lose weight, and allow for early disease detection. Yet, few doctors are providing the service and few seniors are receiving them. What gives? Do they not know of the benefits or are they simply not interested?

I can't profess to know exactly what goes through seniors minds (even though in my past work experience I led an organization that cared for 5 million seniors), as I am a generation younger, but it still breaks my heart that they are not all willing to do whatever they can to live longer, healthier lives.

I can only imagine the fears they have of doing so-fears of developing dementia, fears of running out of money, fears of being institutionalized, or being left alone with the passage of friends and family. These can be legitimate fears as they can and do happen, but early planning can make a difference and I know plenty of seniors who continue to enjoy life into their 90s and beyond. I recently presented to three centenarians, the oldest 103. They all peppered me with questions.

Many seniors don't realize that the longer they live, the more good years they have enjoyed. A researcher at Albert Einstein College of Medicine also concluded that the longer you live, the less you spend on medical care. That may not make sense at first pass, but when you think about it, it begins to resonate. Living longer typically means you have less sick days and that means less visits to doctors, etc. Medical costs are a huge drain as we age and avoiding such expenses preserves our capital.

The bottom line is whether you do it for yourself, for some member of your family, or for any reason that motivates you, take care of your health (and weight) so that you can enjoy a long, healthy life.

BMI formula:

Even In Moderation Still Extremely Dangerous

A few weeks back, I wrote a blog titled Moderation - Not!  I cited numerous examples of where moderation is just a bad policy and included white sugar based products in the group.  I left out one very important example of where moderation is always a mistake.

My friend Mike is a very health conscious individual. He exercises almost religiously every day and generally watches what he eats--except on weekends and special occasions. At such times, when confronted with a delicious looking dessert like cake, cookies, etc. he feels he has license to indulge because he otherwise takes good care of his health. Inevitably, most of these foods contain something beyond sugar that should never even be consumed even in moderation and that is trans-fats.

A little history about trans-fats. They were originally synthesized as a response to the health concerns raised about saturated fats and their relation to heart disease. Trans-fats are created by the "hydrogenation" or adding of hydrogen under high pressure to an unsaturated fat. This creates a compound that has fewer double-bonds than polyunsaturated fats, but more than in saturated fats. Skipping past all the rest of the technical details, suffice it to say that scientists believed that these new fats provided a healthy alternative to saturated fats. They were wrong. Very wrong.

In the 1980, studies began to emerge that demonstrated an even higher than saturated fat incidence of heart disease among trans-fat consumers. One major study following thousands of nurses over decades found a strong linear correlation to heart disease. This meant that the more trans-fat they consumed the more heart disease they had. Other studies showed a strong relation to breast cancer, type 2 diabetes, and inflammation.

In fact, a review published in the New England Journal of Medicine concluded that merely limiting trans-fat is not enough. It needs to be completely eliminated from our diets. Even a slight increase, less than 2%, of trans-fat consumption leads to a significant increase in heart disease.

Although the direct cause of dementia is not yet well established, in animal studies, a strong association between trans-fats and cognitive impairment has been established. The amounts used in the study actually matched well against expected human consumption and therefore should give one pause for serious consideration.

Here's another problem for my friend Mike. I presume he is generally aware of the dangers of trans-fats and regularly checks packaging to avoid them. Here in the U.S., unlike in many other countries, trans fat levels of less than 0.5 grams per serving can be listed as 0 grams trans fat on the food label. Institutions, like cafeterias, are not subject to this requirement. Nevertheless, this 0.5 level is considered by most experts as still too high. (by the way, to know if a product contains trans-fats check the ingredients for the terms hydrogenated or partially-hydrogenated and avoid products with either of these ingredients.)

The other issue is that trans-fats are often used for shortening such as margarine and appear in many fried foods and foods listed as pareve (non-dairy). New York City, fully cognizant of the health risks posed by trans-fats, banned their use in amounts over 0.5% in all of its restaurants in 2008. Other states have been following suit.

Trans-fat also may be consumed in many animal products, like milk, in fluctuating amounts. The bottom line is that it is difficult to completely avoid them. That is why knowingly consuming them, even on weekends and occasionally, is a huge health mistake.  I hope my friend Mike reads this and reconsiders his dietary choices. For that matter, I hope everyone does. By the way, saturated fats remain a health problem and should be equally avoided.

Cures For Alzheimer's Unfortunately Simply Don't Exist - Yet!

Without a doubt, except for cancer, no diagnosis strikes more fear in people's hearts than Alzheimer's. It not only robs memory, but it is also a terminal illness. As far as Alzheimer's diagnosis goes, although there are now some elaborate diagnostic test for it involving injecting dye, etc., most patients are still diagnosed empirically-which means by presenting evidence and ruling out other conditions and causes of memory loss and/or dementia such as mini-strokes, etc.

Given the severity of the disease,  it is not surprising that people so diagnosed as well as their loved ones are often desperately searching for news of a cure.  The current prescription medications available offer little solace and do little to slow disease progression.

I read a recent article about a man duped by a broadcast he watched that presented coconut oil as one such cure. A doctor on the Dr. Oz show offered hyperbaric oxygen therapy as yet another cure. Dr. Mark Hyman told me personally that he has cured Alzheimer's among his patients. I'm not sure there is anything more cruel that handing out false but fleeting hope to hurting people. Today, there simply are no cures for Alzheimer's.

However, there has been progress on the Alzheimer's research front. As discussed, diagnosis has improved.  A new animal model has been developed that may prove useful in someday finding a cure. Scientists now better understand how the disease spreads. There is reason for long term hope.

There are some known supplements that seem to have efficacy in cognition decline. As you know, I am not a fan of supplements in general but the science offers some support for these two. Bacopa for cognition and Huperzine A specifically for Alzheimer's.  Are they cures?  Absolutely not. May they provide some short term relief? Possibly. Their safety profile is not well known so I would only purchase them from a USP or Consumer Lab certified lab. Bacopa is recommended at 150 mg daily. Huperzine A dosages have ranged from 60 to 400 micrograms daily. I would not start these supplements unless under the supervision of a physician.

Do not take either drug if you are pregnant.

Concerns about Bacopa include:

1. Don't take if you have allergies to any member of the Scrophulariaceae (figwort) family. 

2. Adverse effects for bacopa may include drowsiness, palpitations, nausea, indigestion, increased bowel movements, abdominal pain, dry mouth, thirst, muscle fatigue, and fatigue.

3. Do not take with drugs or herbs that are metabolized by cytochrome P450 enzymes. 

4. Take under close medical supervision if you have a thyroid disorders, as bacopa may increase thyroid hormone levels.

 5. Take under close medical supervision if you take calcium channel blockers, due to the potential for additive effects. 

6. Take under close medical supervision if you are taking sedatives, due to the potential for additive effects.

Concerns about Huperzine A include:

1. Don't take if you have allergies to any member of the Lycopodium family.

2. May produce mild-to-moderate nausea and mild and transient ankle edema and insomnia.Close medical supervision is required if taking other acetylcholine inhibitors. May also cause temporary dizziness, sweating, vomiting, diarrhea, dizziness, anorexia, cramps, bradycardia, rash, skin hives, slurred speech, insomnia, excitability, hyperactivity, vision blurring, ankle edema, breathing problems, tightness in the throat or chest, or chest pain.

3. Close medical supervision is required if taking other acetylcholine inhibitors, as adverse effects are potentially additive, in patients with liver disease, as huperzine A appears to undergo hepatic metabolism,in patients with vertigo, as huperzine has been shown to cause dizziness in clinical trials, in patients with asthma, as huperzine A may cause breathing problems and in patients with renal disease, because of the renal excretion of the drug.

As you can read above, these supplements, like prescription medications, have some concerning side effects. So please only use them under close medical supervision.

In the meanwhile, let's all pray for an early cure for this devastating disease we all know as Alzheimer's.