Oct

29

This month in the American Journal of Clinical Nutrition…

“Taylor MK, et al. – Cross-sectional analyses were performed to evaluate the association of dietary glycemic measures with the cerebral amyloid burden and cognitive performance in cognitively normal older adults. The researchers found an association between high-glycemic diet and greater cerebral amyloid burden, which suggested diet as a potential modifiable behavior for cerebral amyloid accumulation and subsequent Alzheimer’s disease risk.“

Amyloid plaguing is the cause of Alzheimer’s disease. In the literature this is now being  referred to as type III diabetes, this article from the American Journal of Clinical Nutrition makes it even clearer why. This is indeed a modifiable behavioral risk factor, as simply reducing  carbohydrate intake markedly reduces this risk. This also reduces risk for diabetes, hypertension, stroke and heart disease, all disorders associated with obesity, which, is also caused by a high glycemic diet. If you have a tendency to overeat carbohydrates, staying full on proteins and (healthy) fats will help.

Mar

11

Various 2012 studies further clarified how excessively sweet, unhealthy foods affect the brain. An animal study out of UCLA found that diets high in fructose can impair cognitive function, which is reversible with omega-3 fatty acid supplementation. High fructose consumption can induce some signs of metabolic syndrome in the brain and can disrupt the signaling of the insulin receptors and reduce the action of insulin in the brain. Other work published in JAMA suggests that fructose consumption modulates the neurophysiologic pathways involved in appetite regulation and encourages overeating. An October 2012 study published in the Journal of Alzheimer’s Disease reported that a diet high in carbohydrates and sugar raises the risk for mild cognitive impairment in the elderly, while a diet high in fat and protein may reduce this risk. Logical yet simple enough, an “optimal balance” of carbohydrates, fat, and protein may help maintain neuronal integrity and optimal cognitive function, particularly in the elderly.

Mounting evidence in 2012 reinforces that high consumption of red meat increases stroke risk. The largest meta-analysis to date looking at the atherogenic effects of red meat found that the risk for total stroke increased by up to 13% for each increase in a single serving of fresh, processed, and total amount of red meat consumed per day. Earlier in the year another study found that processed and unprocessed red meat is associated with a higher risk for stroke, while poultry was associated with a reduced risk. One study found that a diet high in fruits, vegetables, grains, and fish led to a 30% lower depression risk compared with a meat based diet. But, as pointed out last year, meat quality is a factor: Moderate consumption of unprocessed, free-range antibiotic free red meat may actually protect against depression and anxiety. Much of the livestock in the United States is raised on industrial feedlots, which increases saturated fat and decreases very important good fatty acids, whereas pasture-raised animals have a much healthier fatty acid profile.

Information derived from Medscape.

 

Jan

7

A study conducted in Spain reported that consumption of both polyunsaturated fatty acids, (found in nuts, seeds, fish, and leafy green vegetables), and monounsaturated fatty acids, (found in olive oil, avocados, and nuts), decreases the risk for depression over time. However, there were clear dose-response relationships between dietary intake of trans fats and depression risk, whereas other data support an association between trans fats and ischemic stroke risk. Trans fats are found extensively in processed foods, including many commercial chocolates, (hence, check that label when considering dietary intake of chocolate. Also, only the highest levels of dark cocoa contain healthy antioxidants, not milk chocolate). A deficiency in polyunsaturated fatty acids has been linked to attention deficit/hyperactivity disorder in children. Thanks to their high levels of polyunsaturated fatty acids, namely omega-3 fatty acids, fish can help fend off numerous diseases of the brain. A 2010 study correlated fish consumption with a lower risk for psychotic symptoms, and concurrent work suggested that fish oil may help prevent psychosis in high-risk individuals. Although data are conflicting, new research shows that the omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid are beneficial in depression and postpartum depression, respectively, and other research suggests that omega-3 deficiency may be a risk factor for suicide. Oily, cold-water fish, such as salmon, herring, and mackerel, have the highest omega-3 levels. Keep in mind that Atlantic fish have elevated levels of mercury and PCB’s compared to Alaskan/Pacific fish, and that farm raised fish contain very little healthy omega 3 fatty acids, due to the confined breeding of farm raised fish.

Dec

19

2012 Neurology Game Changers, Which Foods Are Best for the Brain?

Dietary advice is common practice in cardiology and primary care, but recently food and drink have become important considerations for neurologists, too. Diet is inextricably linked to conditions such as heart disease, obesity, and diabetes. However, what we consume also seems to have significant implications for the brain: Unhealthy diets may increase risk for psychiatric and neurologic conditions, such as depression and dementia, whereas healthy diets may be protective. 2012 saw coffee and berries warding off dementia, caffeine supplements improving motor function in Parkinson’s and the Mediterranean diet reducing the odds of developing Parkinson’s. Lycopene-rich tomatoes and the flavanones in citrus fruits were found to protect against ischemic stroke. As for what not to eat, a study published in January in Stroke supported previous work linking red meat consumption with higher stroke risk, while diets high in carbohydrates and sugar reportedly raise the risk for mild cognitive impairment and dementia in the elderly. A 2009 study published in the Archives of General Psychiatry found that people who follow Mediterranean dietary patterns — that is, a diet high in fruits, vegetables, nuts, whole grains, fish, and unsaturated fat, (common in olive oil and other plant oils) — are up to 30% less likely to develop depression than those who typically consume meatier, dairy-heavy fare. The olive oil-inclined also show a lower risk for ischemic stroke and are less likely to develop mild cognitive impairment and Alzheimer disease, particularly when they engage in higher levels of physical activity.

All data derived from Medscape, 2012.

Apr

3

Metabolic syndrome, (obesity, hypertension, dyslipidemia and hyperglycemia AKA diabetes), remains a concern in regards to increasing health risk within the United States population.  For the first time in recorded history, our current generation is projected to have a shorter life expectancy than the prior generation.  This is a projection from the New England Journal of Medicine in 2005 based on the current epidemic.  And things have only gotten worse since then.  Metabolic syndrome with its associated cardiovascular disease, stroke, blindness, amputations, etc., accounts for the majority of healthcare dollars currently being spent.  Still worse, current medical treatments focus only on symptoms, which actually make the syndrome worse.  Hyperinsulinemia causes the pancreas to secrete increased amounts of insulin in response to elevated blood glucose.  However, practitioners typically focus on glucose levels or hemoglobin A1c, and prescribe drugs which actually increase insulin levels even further.  In a typical case, a patient would present with obesity, hypertension, diabetes and elevated blood lipids.  The patient would be told to lose weight by eating more fruits and vegetables and to cut down on fats and cholesterol and to do some light exercise as a standard first-line therapy of lifestyle changes.  This certainly stands the test of reason.  The problem is that under this regimen, the syndrome actually worsens.  Eventually antihypertensive medication is prescribed as are drugs for diabetes.  Soon the patient finds themselves on 6 or more drugs with no improvement in their status.  The underlying problem is that nothing has been done to address their insulin resistance.  A more appropriate course of treatment in this scenario would be the use of a muscle sparing protein diet and more importantly carbohydrate restriction, consisting mainly of fiber and vegetables, keeping in mind that all carbohydrate, with the exception of fiber, will eventually be turned into blood glucose either quickly or slowly.  By restricted carbohydrate intake, insulin secretion can be reduced and thus reducing insulin sensitivity/resistance.  In doing this, weight loss can occur and the patient’s syndrome can actually reverse.  If you suffer from any of the symptoms associated with metabolic syndrome, you should consult with myself and/or your family physician before undertaking any therapeutic regimen as in extreme cases drug therapies may be appropriate to reduce risk of stroke and/or other consequential risks.

Sep

19

Over the last few years it has become such that you cannot watch one television show without seeing at least a few commercials for drugs.  Not surprisingly, during the part where they list the adverse side affects attributed to the drugs, there is a very attractive young lady smiling and dancing and throwing rose pedals.  Drugs have become more accepted than breakfast in our “better living through chemistry” society.  Well, a recent study published in the archives of internal medicine, depicts a disturbing picture of our societies interpretation of these ads.  Of the thousands of individuals involved in the study, thirty-nine percent mistakenly believed that the FDA approves only “extremely effective” drugs; 25% mistakenly believed that the FDA approves only drugs without serious side effects.   In conclusion this study found that a substantial proportion of the public mistakenly believes that the FDA approves only extremely effective drugs and drugs lacking serious side effects.  This is hard to believe as the side effects are indeed mentioned at the end of each commercial.  It would seem that no one is paying attention for this part.

When I meet with new patients as part of my initial history taking process I ask each patient which drugs they are taking and why. I find that about 20% of my patients on initial consultation do not know why they are taking their drugs, and, many are taking more than six different drugs.   If you are taking prescription medication, you should be aware as to what you are taking and why you are taking it.  Learn the side affects of drugs which you may be taking as well, should you experience any of them. If you are on high blood pressure medication, buy a home blood pressure unit and check your own blood pressure daily.  It is not uncommon for me to meet with a new patient suffering with dizziness only to find out that they are on high blood pressure medication, have lost weight, and are still taking a high dose from before their weight loss and that this is causing there dizziness from low blood pressure.  Drug therapies are still drugs, and they should be used with diligence and with prudence.  Act responsibly and know all of your options before blindly going on drug therapies, as ultimately, you are the one taking the drug.

 

Nov

8

Recent research on healthy aging shows that poor habits such as smoking, drinking too much alcohol, inactivity and poor diet, can age you by 12 extra years.  The findings are from a recent study that tracked nearly 5,000 British adults for 20 years, aged 18 and older and 44 years old on average, and they highlight yet another reason to adopt a healthier lifestyle.  Overall, 314 people studied had all four unhealthy behaviors. Among them, 91 died during the study, or 29%.  Among the 387 healthiest people with none of the four habits, only 32 died, or about 8%.  “Bad habits” are said to include: smoking tobacco, drinking in excess of three alcoholic drinks daily for men, two for women, engaging in less than two hours of physical activity per week, and consuming fruits and vegetables fewer than three times daily.  These cumulative habits substantially increased the risk of death and made people in this group seem 12 years older than people in the healthiest group.  The most common causes of death in the study included heart disease and cancer, both known to be related to unhealthy lifestyles.  The study appears in the Archives of Internal Medicine.  The healthy group included individuals who did not meet the criterion for “bad habits”.

It should be possible for most people to manage meeting the healthy test group’s habits, and further, each step in this direction reaps rewards of better health.  The U.S. government generally recommends at least 4 cups of fruits or vegetables daily for adults, depending on age and activity level; and about 2 1/2 hours of exercise weekly, which equates to thirty minutes daily five days a week.

In a separate American study, no progress appears to be being made with respect to changing “bad habits”.  The rates at which Americans take part in exercise remains unchanged since 1997.  We are a long way from where the health experts want us to be with respect to smoking.  Overall, about 66% of adults in the USA are either overweight or obese.  About one-third of people are in the obese category, meaning they have a body mass index of 30 or greater.  In yet another American study, extremely obese people, those who are 80 or more pounds overweight, live 3-12 fewer years than their normal-weight peers.