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.

 

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.

Aug

6

This week I would like to talk about exercise.  For the most part the word exercise appears to be a foreign word lately. I started exercising when I was 13, and I haven’t stopped since.  At the gym each day I see a myriad of individuals trying to stay fit, but in reality this is only a small minority of the population at large.  Our society has now become so obtuse in their habits that getting an extra fifteen minutes of sleep trumps an exercise regimen.  I hear excuses in my office all day long, from “I have kids”, to “my job doesn’t allow me the time”, and on and on.  I have yet to hear a reason that is not merely an excuse to not have to exercise. Quite simply, these excuses are in reality a way of stating that exercise is just not a priority.  The simple truth is that by not getting needed exercise, in effect, you are pretty much agreeing to a shorter life expectancy, which by the way, is predicted to be shorter for the first time in history with the upcoming generation associated with diabetes, hypertension and all of the syndromes associated with lethargy and poor eating habits.  Humans were not put on this earth to sit and watch television and eat yodels.  Genetically and historically, we essentially were out chasing food, or being chased as food.  Because of technology, it is now quite easy to not have to move much during the day, and even easier to eat pre-made stuff full of preservatives and chemicals with no real nutritional value whatsoever.  If you have already lost your health because of poor eating habits and lack of exercise, you should probably discuss any upcoming exercise plans with your doctor first.  However, if you still have your health, doing anything is better than doing nothing. And the more fit you are, the higher the intensity should be your exercise. As an example of light exercise, when going to the market, rather than driving around stalking that close parking space, take a far one and walk. If you are able, jogging in place for several minutes is great exercise.  Doing so in say 8 intervals of 20s of jogging with 10s of rest is extraordinary.  Just three days per week of this would actually change your health as well as your body. If you do the math, that is 4 minutes, three days per week.  Can you still honestly say that you do not have the time? Not if you are truly honest. For those interested in maximizing their fitness regimens, I have already published several articles on that topic which are readily available, (search word: HIIT), on the fitness page and in the articles section of my website.

May

21

Over the years I have authored several articles on vertigo, dizziness and imbalance, mostly pertaining to treatment, as treating these disorders is my specialty.  So how do you avoid getting them in the first place? Well, not so easily for some, quite easily for others.  Lets first talk about vertigo.  The most common causes of vertigo simply cannot be volitionally avoided outside of recommending that you do not bang your head.  Vertigo seems to attack everyone at some point or another, some being more predisposed to having repeat attacks.  The good news however is that the disorder is quickly remedied, at least in my office.  If you do get vertigo you do want to come in and get it treated quickly as it typically only gets worse, and more importantly it invariably leads to imbalance, which causes falls, which are much more difficult to recover from and often times you do not.  So the longer you wait to get vertigo treated the more a fall becomes imminent.  As some types of vertigo can be caused by swimming, particularly in lakes, cautions should be taken to avoid getting water in the ear canals. Dizziness, is actually different than vertigo, the latter having a rotary type feeling.  Causes of dizziness are vast.  It is the main side affect from any drug.  High or low blood pressure can cause dizziness as can variations high or low in blood sugar.  If you are taking drugs for high blood pressure, it is always a good idea to have a home unit so that you can monitor your pressure and maintain a log, which you can share with your doctor.  If you gain or lose weight and your daily recordings start to change, you need to inform your prescribing doctor immediately as the drug dosages may require titrating upward or downwards. Similarly, changes in blood sugar are associated with diabetes, which if not kept in check will cause dizziness. Alternatively, a pre-diabetic state where there is simply too much sugar in the diet, hypoglycemia, (low blood sugar), which many people are susceptible to from skipping meals too long or eating poor quality, (low nutritional value), foods can also cause dizziness.  If you do not have any of these conditions, it is a good idea to continue to do things in your best interest to keep it that way.  Eat healthy and exercise regularly.  See a doctor regularly to have your blood pressure checked and have blood work done annually.  It would be appropriate to mention eye exams as well as changes in vision as well as ocular diseases are a cause of dizziness. Imbalance, is usually a side effect of vertigo or dizziness.  However, it can occur without and typically does as we age although this needn’t be the case.  Imbalance is typically associated with aging primarily because the eyes and spine work differently together as the spine becomes arthritic, which is inevitable as we age.  If this is not corrected imbalance is the result.  My office offers free screening exams for imbalance and the test only takes twenty seconds, and it is the standard in the industry for fall risk analysis currently.  As with blood pressure and blood tests, fall risk analysis should be performed routinely every few months.  There is no downside as there is no prep required for the test and results are immediately available.  And if it means averting a fall the service is invaluable.

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.

Nov

7

Each week I see patients who have recently been examined by their primary doctors and are told that have findings of high blood pressure, elevated blood sugar or both. They are ill advised to return for followup in 8 weeks for a second test. I am not suggesting that it is wrong to followup when you have such finings. It is however foolish to make no management recommendations and expect a different outcome on a subsequent visit. Often on the next visit medication will be prescribed as now there is a trend and not just a single visit finding which may have been just coincidence. It is necessary to show a trend vs. a single visit reading to prescribe drug therapies unless hypertension is severe. It is reasonable that if someone is found to have high blood pressure, or, blood work reflects elevation in blood glucose, that rather than simply recording such data for record keeping that lifestyle modifications would be immediately discussed and proposed as being not only appropriate but necessary. Again, it could be argued that simply having an elevation in blood glucose does not mean that you are diabetic. Currently the diagnosis of diabetes is based on a blood test called the Hemoglobin A1c. However, if your blood test is demonstrating elevation in glucose, you are currently in a prediabetic state that needs to be addressed, not just monitored until such point that you definitely have diabetes, as is the case with an enormous number of Americans. If you have either elevated blood glucose or high blood pressure there are definitive lifestyle changes that you need to be making, now, not later. These changes do not merely mean kicking back and awaiting a drug therapy. It is this combination of blood glucose elevation and hypertension that constitutes the metabolic syndrome, a leading cause of disabilities, stroke, heart disease and death in this country, and it is getting worse each year despite drug therapies. When I meet with my patients I routinely discuss all aspects of their health. Most patients come to see me for dizziness and balance problems as well as other brain based disorders, but this doesn’t mean that I can’t help them get their life back if they are dangerously hypertense or prediabetic. In fact, I believe it is my job.

Nov

29

Diabetes mellitus is a chronic metabolic disorder affecting about 6% of the population worldwide with its complications, and is rapidly reaching epidemic scale. Diabetes mellitus has long been known to be a cause of dizziness, associated with sudden changes in blood sugar levels too high or too low.  Metabolic syndrome is associated with insulin resistance, elevated glucose and lipids, inflammation, decreased antioxidant activity, increased weight gain, and increased glycation of proteins. Cinnamon has been shown to improve all of these variables in both animal and human studies. In addition, cinnamon has been shown to alleviate factors associated with Alzheimer’s, ischemic stroke and studies also show that components of cinnamon control new blood vessel formation associated with the proliferation of cancer cells. Human studies involving control subjects and subjects with metabolic syndrome, type 2 diabetes mellitus, and polycystic ovary syndrome all show beneficial effects of whole cinnamon and/or liquid extracts of cinnamon on glucose, insulin, insulin sensitivity, lipids, antioxidant status, blood pressure and on lean body mass. However, not all studies have shown these positive effects of cinnamon, and type and amount of cinnamon, as well as the type of subjects and drugs subjects are taking, are likely to affect the response to cinnamon use. There are however no studies suggesting adverse affects of cinnamon use. In one study, the median lethal dose of cinnamon could not be obtained even at 20 times (0.4 g/kg body weight) its effective dose. With the high margin of safety of cinnamon, it appears useful as a potential therapeutic candidate for the management of diabetes.  As such, the use of cinnamon may be important in the alleviation and prevention of the signs and symptoms of metabolic syndrome, type 2 diabetes, and cardiovascular and related diseases.  I have been recommending its place in the diet for years to my patients, particularly those whom are diabetic or suffering with the aforementioned disorders.

Extensive research within the past two decades has revealed that obesity, a major risk factor for type 2 diabetes, atherosclerosis, cancer, and other chronic diseases, is a pro-inflammatory disease. Several spices have been shown to exhibit activity against obesity through antioxidant and anti-inflammatory mechanisms. Among them, curcumin, a yellow pigment derived from the spice turmeric (the main ingredient in curry powder), has been investigated most extensively as a treatment for obesity and obesity-related metabolic diseases. These curcumin-induced alterations reverse insulin resistance, hyperglycemia, hyperlipidemia, and other symptoms linked to obesity. Other structurally homologous nutraceuticals, derived from red chili, cinnamon, cloves, black pepper, and ginger, also exhibit effects against obesity and insulin resistance.

Jul

27

Diabetes is becoming more common and more of a medical problem than ever before.  I am specifically referring to type 2 diabetes, which is invariably brought on entirely by ones eating habits.  This is why it has earned the designation “adult onset diabetes”.  The “juvenile” type, or type 1, occurs at an early age for other reasons entirely.  So let’s discuss type 2, since that is the big problem and since it is entirely in your control to remedy.  Quite simply, type 2 diabetes occurs associated with obesity.  For each pound of “extra” weight one carries, risk of diabetes rises, exponentially.  As an example, someone 30 pounds overweight has a 4000% increased risk in becoming diabetic.  (This is not a typo).

Heart disease and peripheral artery disease are the biggest complications that people face with uncontrolled diabetes. Approximately 65% of death from diabetes is due to heart disease and stroke.  Peripheral artery damage or nerve damage, also from uncontrolled diabetes, can lead to foot problems that can lead to amputations. More than 60% of leg and foot amputations not related to an injury are due to diabetes.  Diabetes is the leading cause of blindness in this country. Other problems include glaucoma, cataracts and diabetic retinopathy.  Studies show that regular eye exams and timely treatment of diabetes-related eye problems could prevent up to 90% of diabetes-related blindness. Recent studies correlate metabolic syndrome with marked increase in total fructose intake in the form of high-fructose corn syrup, beverage and table sugar.  Metabolic syndrome is a name given to a group of risk factors including heart disease.  If you learn to read labels, you will find that many products now contain high fructose corn syrup.

Dizziness, a common problem in and of itself, is often associated with deregulation of sugar.  Sugar levels, both too high, and too low, will lead to dizziness. Your body does a delicate balancing act trying to maintain as steady a level of blood sugar as possible.  You can help this cause  by maintaining a healthy diet that does not cause blood sugar levels to suddenly go through the roof, or conversely, waiting all day to eat causing them to plummet.  More information on healthy eating tips can be found on my website.  Much of the dizziness which I see clinically is ether caused by or complicated by extreme variations in blood sugar levels.

Of equal importance is exercise.  Humans were not meant to be sedentary, which unfortunately, is how many Americans spend their day. Exercise should be performed at the highest level of your ability.  If you are unsure of your ability, you should discuss it with your doctor.