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.

Are all fish equally healthy?

I would like to preface today's blog by stating that it would take a book to do real justice to this subject.

A few months ago, I wrote a hearty defense of fish as part of a healthy diet.(see http://mdprevent.blogspot.com/2013/03/in-defense-of-fish-consumption.html). Since that time, meaningful studies continue to emerge supporting the value of including fish.  A recent study showed that pesco-vegetarians (vegetarians who also consume fish) do better than any other category of eater, including pure vegans, when it comes to overall mortality. The study, however, did not distinguish among types of fish.

In my practice, I counsel many patients about the importance of consuming fish. Many patients say they already do. On closer scrutiny, it turns out that most are eating tilapia, farm-raised salmon, and canned tuna fish.  When I recommend fish, these are not my first choices. As a choice, they are undoubtedly preferable over hamburgers, hot dogs, and cured meats. They are also superior to other forms of red meat and caged fowl. But when it comes to choosing among fish, they rank low.

My first choice and champion remains wild Alaskan Salmon. One of the great things about wild Alaskan Salmon is that the salmon is often caught after it spawns and closer to the end of it's life cycle. This allows for sustainability of the species and is ecologically friendly.

I make a point about Alaskan salmon because wild Alaskan salmon as opposed to its Oregon and California counterparts, has far less Polychlorinated biphenyl (PCBs) contaminants. In fact, last year, Oregon issued a safety alert about wild Oregon Salmon being highly contaminated. So please take note when selecting wild Salmon, it's source is equally important to it being wild.

Tilapia and other farm raised fish, including salmon, contain far less of the essential Vitamin D and health promoting omega-3s than does wild Alaskan Salmon. In fact, wild Alaskan salmon has four times the Vitamin D as it's farm raised equivalent. Wild salmon tends to be leaner, having less saturated fats, and is an excellent and essential source of Vitamin B12 and protein. It alo contains an generally considered healthy anti-oxidant called astaxanthin. Free of articial dyes, food additives, antibiotics and growth hormones, Wild Alaskan salmon is my ultimate food.

What about other fish?

I like wild sardines and herring. As small, non-predatory fish, they also contain few contaminants and are high in omega-3 fatty acids. Costco and many supermarkets sell wild sardines in a can and wild herring in wine sauce.

What about tilapia, a perennial favorite?

Here's a snippet from Wikipedia discussing the problem with tilapia.

"Typical farm-raised tilapia (the least expensive and most popular source) have low levels of omega-3 fatty acids (the essential nutrient that is an important reason that dieticians recommend eating fish), and a relatively high proportion of omega-6. "Ratios of long-chain omega-6 to long-chain omega-3, AA to EPA, respectively, in tilapia averaged about 11:1, compared to much less than 1:1 (indicating more EPA than AA) in both salmon and trout," reported a study published in July 2008. The report suggests the nutritional value of farm-raised tilapia may be compromised by the amount of corn included in the feed. The corn contains short-chain omega-6 fatty acids that contribute to the buildup of these materials in the fish."

Tuna, wild or otherwise, is a predatory fish and therefore accumulates lots of mercury. As does cod, halibut, sole, lobster, shrimp, etc. Again, given the choice between red meat and these seafood, the fish are better. Of course, that assumes the fish are not soaked in butter or drenched in a fatty mayonnaise.

The evidence against red meat and dairy, by the way, continues to mount. The recent link of L-carnitine, a by product of meat and whey protein degradation, with inflammatory heart disease, combined with the well established dangers of high saturated fat consumption in terms of heart disease, cancer, stroke, dmentia, etc. should give you meat eaters serious pause for reconsideration.

There's nothing fishy about wild Alaskan Salmon. How about some for dinner?

Ginkgo Biloba, Dr. Oz, and Memory

On his Friday May 31, 2013 show, Dr. Oz stated emphatically that there is no conclusive evidence that Ginkgo Biloba in supplement form helps or hurts. He cited recent animal studies that suggest Ginkgo may cause certain types of cancer, but they were only studies in rats and mice. He stated that there are other studies that suggest benefits. His conclusion based on consulting his "experts" was that one is better off not taking it.

Is this news? Not to Steven Novella, MD, an American clinical neurologist and assistant professor at Yale University School of Medicine, who appeared on the April 26, 2011 episode of the Dr. Oz Show and argued this very point. Dr. Novella stated during that episode that the evidence to support the use of Ginkgo Biloba was inconclusive and Dr. Oz pushed back. (See http://www.doctoroz.com/videos/alternative-medicine-controversy-pt-1)

As I wrote in my last blog about other supplements and you may have just seen at the link above, Dr. Oz hasn't always been so neutral about recommending Ginkgo.

Still not convinced?

Check out the following links to see for yourself.

Here's a video I plucked today from his website that shows another previous episode of his show.

http://www.doctoroz.com/videos/does-it-work-ginkgo-biloba

Want more?

Here's a quote from a website called Realage.com in which he has an ownership stake:

"What is Ginkgo Biloba?

RealAge answered:

The ginkgo tree, also known as the maidenhair tree, is one of the oldest living species in the world. This hardy, deciduous tree is cultivated on plantations in many parts of the world, primarily in the United States and China. Ginkgo leaves are picked, dried and extracted to manufacture ginkgo products, which are marketed widely.

Extracts of Ginkgo biloba can be used to treat the following:

• limping due to insufficient peripheral blood flow (disorders of peripheral circulation, or intermittent claudication)
• memory loss due to general mental deterioration (dementia) or physical disorders that cause a decrease in mental function (organic brain syndrome)
• dizziness (vertigo) and ringing in the ears (tinnitus), originating from insufficient blood supply to the inner ear"

Still hungry for proof?

Here's another quote from Sharecare.com, a website he jointly owns and which purchased Realage.com.

"What are the benefits of Ginkgo Biloba?

Dr. Mehmet Oz answered:

Ginkgo biloba improves mood and can help prevent macular degeneration.Watch the video to find out from Dr. Oz about the other benefits of ginkgo biloba."

I can't make this stuff up. Dr. Oz is sowing a great deal of confusion by stating one thing one day and flipping on it the next. The worse part, he doesn't bother to clean upon the web and his own site of the old "wrong" information he previously shared. It's obvious he's not taking anything for memory. He must also think his audience also has a poor memory and can't remember what he previously said.

I wonder if we all wouldn't be better off if Dr. Oz just kept his mouth shut? What do you think?

As for Ginkgo Biloba for memory, forget it.

Dr. Oz says Oops - Again!

Ye faithful readers of this blog know of my disdain for Dr. Oz's almost daily pronouncements about the value of taking one supplement or another. On a slew of recent shows, in the face of irrefutable evidence, the good doctor has started to backtrack on a number of his prior recommendations.

On one show, he cut his calcium recommendation in half. Sounds good, but the recommendation was arbitrary. Instead of explaining to people that they shouldn't exceed a total of 1,400 mg of calcium from a combination of pills and food (emphasis on pills) as the study upon which he referenced showed, he still recommended 600 mg. The study showed that if you get all your calcium from food, there are no adverse effects.  But he couldn't bring himself to flat out state that people should avoid the pills altogether. His show's sponsors and other friends in the supplement industry would not appreciate that call.

On another show he cautioned against using L-Carnitine, an amino acid derivative found in meat and dairy products (such as protein drinks, bars and powders containing whey), which during multiple other shows he readily admitted advocating that people should take it. L-Carnitine has now been shown to be strongly related to development of heart disease.  Nice that he says now to stop, but what about the potential tens of thousands of people who took his prior advice and harmed themselves in the process?

Finally, on a third episode, he cautioned viewers that multivitamins may be harmful because their manufacturers may not adhere to ethical standards of producing exactly what the label states is inside. Read my prior blogs to discover that's the least of the problems with taking multivitamins. Don't take multivitamins unless prescribed by your physician.

So on one hand, we should all be very pleased that the good doctor is willing to admit his mistakes. I know I am. Yet, while he backtracks on some products, he continues to advocate for other products that also lack scientific merit, such as still pushing probiotics for general use. (See my multiple blogs on probiotics.)

It is said that the key to computer artificial intelligence is for the machines to learn, particularly from their mistakes. One would expect no less from a licensed physician. Would it really be too much to ask for him to vet his products,. e.g. requiring conclusive scientific evidence before support their use on national television?

If you are still watching his show, for the umpteenth time I say, enjoy it as entertainment, but under no circumstances follow his advice without first consulting your physician.  If his advice harms you or even kills you, his later disavowal won't do you much good.

Finally, those who watched the shows I just referenced may have noted that while he admitted he gave bad advice, he never apologized for doing so.  Therefore, let me say I am sorry on his behalf.

Guns and Cancer

If you saw a stranger carrying a gun enter your neighbor’s house, would you get involved and call the police?  I think most people would agree that's the right thing to do. Recently, guns have been a main topic of conversation because of their most recent role in the senseless tragedy at the Sandy Hook school and the subsequent political efforts to make obtaining guns more difficult.  Major gun violence like Columbine and the DC Sniper always grip the national attention. Yet, according to statistics published for 2010, the death rate for guns in the US is about 1 in 10,000.  According to a 2004 report published by the Centers for Disease Control, there are over 100 more likely causes of death than guns. (See  http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_05.pdf).  Nevertheless, gun violence remains one of the most hotly debated and media covered issues in our country.

Cancer, on the other hand, according to the American Cancer Society, is responsible for 25% of male deaths and 20% of female deaths. So why in our society is there relatively little discussion about preventing cancer? True, there are plenty of public efforts around early cancer detection like getting colonoscopies and mammograms. Pink lapels are everywhere, but it's not nearly enough. (See my blog on Cancer: Prevention or Detection? at http://mdprevent.blogspot.com/2013/05/cancer-prevention-or-detection.html.)

Yet, other than encouraging smokers to stop and people of all ages to avoid the sun, we barely scratch the surface of the cancer topic.  (By the way, speaking about the sun, except for those most prone to skin cancer, most people should get at least 15-30 minutes of direct sun each day at non-peak hours to naturally produce Vitamin D and melatonin. One interesting recent study showed that higher blood levels of melatonin were associated with a lower rate of diabetes.).

So even though cancer is ubiquitous and everyone knows someone who has been diagnosed, treated, or passed from it, we as a society generally prefer to ignore the topic when possible. Why? As my wife likes to say, "it's just morbid to discuss it." I agree. Discussing cancer neither makes for good table-talk nor is it very popular topic at almost any other time.

It may be polite to avoid the topic, but is it smart? Is it time to overcome our distaste for the subject and bring it front and center?  Should we discuss it with friends and neighbors, our children and other relatives, co-workers, and even strangers? Should the halls of congress echo with debates on this topic greater than virtually any other? The answers depend on how much we value life and to what extent we are willing to go to preserve it.  What's the alternative? Continue to by and large avoid this difficult topic and in turn, sacrifice meaningful collective efforts to identify the major culprits.

The other question you may be asking is can and will such discussions change anything other than the mood of those involved? The scientifically valid answer of the moment is for some people, it simply won't matter. That's because scientists believe today that cancer is the result of damage to one's DNA and random mutations. In other words, some people are so genetically susceptible to developing cancer, that they cannot reasonably be expected to avoid all environmental triggers that have already and will continue to damage their DNA. Also, as far as researchers know right now, no one can completely avoid the random mutations that create cancer cells.

But for many, if not most, people, vigilance and caution could make a huge difference. For example, next on the list after smoking, being overweight is probably the most significant cancer risk factor. Obesity has recently become a hot topic, but mostly because of its effects on heart disease and diabetes, even though being overweight is the second greatest risk factor for cancer. Is it the extra weight, the type of food consumed, or the lack of exercise that creates the added risk? The answer is unclear.  Maybe it's all three. For example, a new study reveals the mechanism behind why exercise decreases a woman's risk for breast cancer. It is related to the changes to estrogen brought about by exercise. Exercise is good and women who exercise are less likely to develop breast cancer. When was the last time you heard that exercise prevents cancer?

When it comes to guns, we recognize their implicit danger. Guns take lives unexpectedly and can create peril at any time.  Most Americans agree that limiting the spread of guns is a necessity and a moral imperative. Unfortunately, efforts to limit gun access usually only affect law-abiding citizens and not those able to obtain firearms by criminal means.  In contrast, except in relation to children, and even in that regard the efforts are paltry, there is virtually little effort by citizen groups or the government to limit the hazards of chemically infested foods we regularly consume.

Some isolated groups are waging campaigns. For example, the Environmental Working Group (ewg.org, a non-profit organization, has developed a list of fruits, vegetables, and other household mainstays with the highest pesticide and chemical residues.  However, the truth be told, the science showing a cause and effect relationship between these products and cancer is relatively limited and inconclusive. Is it limited because there isn't any link, because it doesn't exist, or because Big Food prevents it from seeing the light of day, I can't tell you. While the dangers may be real, they are unproven.

Yet, although I'm not trying to instill paranoia, I still think the principle of what you don't know may still harm you, may apply.  One cannot imagine much benefit to our body from the countless chemicals we consume.

That's why caution is in order when consuming conventional fruits and vegetables. Although a major study from Stanford showed that such produce is no less nutritious than organically grown counterparts, soft-skinned conventionally raised produce is full of chemical contaminants. If unavoidable or the only type you can afford, then wash it thoroughly before eating.  Choose your household cleaning products carefully, opting for more environmentally friendly products when you can, and always protect your skin and  airways when using such products. Avoid, whenever possible, and otherwise limit consumption of all processed foods replete with a multitude and variety of potentially harmful chemicals.

If you saw a stranger with a gun entering your neighbor's house, you would probably assume the worse. Just because you do, doesn't mean he intends harm to your neighbor. Yet, you would still be alarmed. So why are you any less cautious about the foods and products you come in contact with and allow to invade your body that are strongly linked to cancer and other diseases?

No one can promise you that you will crimp your own cancer development. With 50% of men developing cancer and 33% percent of women doing so, your odds of avoiding cancer are not great.  (I'm sorry for being morbid, but those are the facts.)  However, I can tell you with confidence after reviewing over twenty thousand related studies, that living a healthy lifestyle will shift the odds in your favor.

If you value your health and your life, isn't it worth the effort? Again, there are simple things you can do such as avoiding processed foods full of chemicals, taking precautions with cleaning products, and carefully washing your produce to remove as much residue as possible. Little things may actually matter. This may be one of those situations where you can actually create your own luck. Avoiding cancer is important because prevention really is preferable to cure.  Hippocrates knew this 2,500 years ago and it's even more true today. As Louis Pasteur once said, "Chance favors the prepared mind."

No one should experience the daily agony my relative must now bear.  Please heed my words and decrease the probability that you or a loved one will ever experience the same.  Bet on yourself and your loved ones.

Thoughts Are Not Facts: A Short Tale About Lycopene

A patient recently came to see me for an Annual Wellness Visit. This is a service paid for by Medicare that involves completion and review of a health risk assessment. As part of the process, I review the patient's list of supplements and advise if they are appropriate.

The patient told me that her doctor had recently sold her a bottle of lycopene to help alleviate her symptoms of urinary frequency, the need/urge to urinate more than usual.  Lycopene is a nutrient found in foods like tomatoes and watermelon and is considered an antioxidant because it is believed to neutralize free radicals.  It is often associated with reducing the risk of prostate cancer, but studies are inconclusive.

In this particular patient's case, she stated that since starting the lycopene, her frequency of urination had decreased.  This was not conjecture or fanciful imagination. Her getting out of bed at night to urinate had definitely gone down.  As anecdotes go, this one seemed fairly reliable and good evidence of the power of lycopene to help. If this person had been asked to swear out testimony about the benefits of lycopene, she would have done so without hesitation.

There was only one problem. Starting lycopene had nothing to do with why she had decreased her urge to pee.  First of all, I was suspicious because even if lycopene was responsible, its mechanism of action would not have made such a difference in such a short period of time.

More importantly, something else was going on. This patient usually took a diuretic pill for her blood pressure. A diuretic forces the kidneys to excrete more water and people who take them often complain of urinary frequency to the drug's effects.  As it turned out, around the same time that the patient started taking the lycopene, she had nearly depleted her diuretic medication and started taking it every third or fourth day instead of daily as required.  Under a reduced diuretic regimen, she was experiencing an obvious decrease in water expulsion.

The patient did not realize the overlay of this fact with her changed situation.  I made the connection for her. The mystery was solved. She now understood that the lycopene was not responsible.

Please don't get me wrong. I am not opposed to consumption of lycopene in fruits. In fact, friends, relatives, and even some strangers will tell you that I am a rabid fan of watermelon.  I can never get enough.  The only precaution I must take when eating watermelon is not too eat too much too late in the day or I will have to wake multiple times during the night to go to the bathroom.

The moral of today's story is just because a patient (or you) thinks that a supplement is helping you, doesn't mean it's true. It may be, but unless you have a scientifically valid way to verify it, you may be ignoring something else and wasting your time on unhelpful, if not potentially harmful, pills. You may even be experiencing a placebo effect or there may be other valid reasons for what you are experiencing. Be careful my friends.

Cancer: Prevention or Detection?

I recently spent a couple of days with my relative who is grappling with cancer.  It gave me plenty of time to reflect on what cancer represents.  Cancer is not only about the threat to our health and life; it is also about the physical and emotional agony it causes. No one should have to endure it.

On the plane back from the visit, I noticed an article in Delta's complementary airline magazine about the partnership forged between Delta and the American Cancer Society. The article spoke about the importance of cancer prevention and how it relates to cancer screening. To be fair, detection of cancer is really not prevention at all except if it is referring to prevention of death. There is no doubt that certain detection tests like annually checking for blood in the stool and a digital rectal exam are helpful in finding cancer early and potentially avoiding another cancer caused death.  But detection tests do not prevent cancer.

In fact, there are very few things most people do or even doctors advocate to prevent cancer. The HPV vaccine is one rare example. Not smoking is another. Avoiding obesity has become a more common refrain. The question is, however, given the ravages of and pain and discomfort caused by cancer, which I just witnessed first-hand, why isn't there a greater focus on actual cancer prevention?

Recent studies have revealed the extent that gene mutations play in cancer development.  What continues to baffle researchers are the specific causes of these gene mutations. Is it hereditary or environmental? Is it fate or self-fulfilling?  I will not pretend to have the definitive answer because it is simply unknown. Yet, here is what we do know. Chemicals can cause gene mutations. This is a fact beyond a shadow of the doubt. We are exposed to chemicals in so many forms they seem unavoidable. They exist in our foods, on our foods, from the products we eat our food with, wrap our food, store our food, etc. They are in products we put on our bodies, and inhale on a daily basis. While they are ubiquitous, it doesn't mean we should take comfort in the old adage that "everything causes cancer so you can't avoid it and you shouldn't try."  This type of outdated thinking is a mistake and displays serious denial of the risks of unrelenting exposure to dangerous chemicals.

So what's a person to do? What if you can't afford to buy organic, have to live where you work, can't eliminate all the chemicals in your house? The answer is: do the best you can, but don't ignore the threat. No one can guarantee that your efforts will pay off any more than buying a lottery ticket is a sure thing. However, unlike a lottery ticket or placing a bet in a casino, making a conscious effort to limit your chemical exposure, particularly in your food, may spare you unimaginable pain and grief.

So take the time to read labels and if you don't recognize an ingredient, don't let the so called food pass through your pearly gates, your teeth. You may not be able for yet inexplicable reasons to prevent cancer, but don't let your ignorance be the cause of it.

I apologize for the solemn tone of today's blog, but watching my relative suffer close-up makes me want to do everything and anything to spare others from the same fate. It's your health. It's your life. Please take control.