Old but Not Aged
Alzheimer's Updates
Alzheimer's and Healthy
Living
Diet, Fats, and Inflammation
Ask Dr. J: Vitamin
B3 Safety
References
In the Health News
Diet and Disease
Recipe of the Month:
Grilled Salmon and Veggies
Dear Friends,
I have recently been in touch
with an elderly patient and an
older colleague to ask them about
their secrets of longevity. My
patient has just turned 103 years
old, and my colleague is still
going strong at 87 years old,
witih a private practice and an
ongoing writing and lecture schedule.
How do they do it? They choose
good health practices, physical
activity, and consistent use of
mental faculties in creative and
rewarding ways. It does not hurt
to have good genes, but it is
clear that genetics are not responsible
for the vast majority of degenerative
diseases or accelerated aging.
My colleague and friend is Dr.
Abram Hoffer, who was one of the
earliest proponents of the use
of dietary supplements in high
doses for both prevention and
treatment of disease. In the early
1950’s Dr. Hoffer studied
the effect of high doses of nicotinic
acid (vitamin B3) in schizophrenic
patients. He and his colleague
found that a number of these patients
responded dramatically, with improvement
in mental function and reduction
of their dependence on medication.
This was the first double-blind
study in psychiatry, and he published
a number of later studies.
Dr. Hoffer’s continued
good health is partly the result
of his following his own advice,
as I know he takes many supplements,
including vitamin B3 and vitamin
C, among others. His continuing
to write, practice, and teach
also helps, I am sure, in the
maintenance of his vigor, vitality,
and mental clarity. As he was
one of my early teachers, I admire
the way he practices what he believes
is best for both himself and his
patients, and he is an inspiration
to other colleagues. He is also
open to new ideas and incorporates
them into his practice and his
life. It is encouraging that at
any age, someone with the right
mindset can have an interest in
learning and incorporating new
ideas.
My patient was practicing good
health habits ever since her mother
died early at 48 years old. She
consulted with me first in the
late 1980’s for more thorough
advice, and although she is now
too far away to see me, she is
amazingly resilient (although
not without some health problems).
I know that she has had a long-term
interest in healthy foods, and
several times lamented to me about
how overprocessed our foods are,
sometimes even the ones we cook
at home. Her determination to
age well and live healthfully
is part of the reason for her
success.
Maintaining rewarding social
interactions, with strong support
from family, friends, colleagues,
and the community, is also helpful
in avoiding illnesses that are
promoted, if not caused, by stress
and isolation. This is not to
completely discount genetics and
other influences in our lives,
but to more valuably focus our
energy and time on lifestyle choices
that we control.
Alzheimer’s disease (AD)
has recently received wide attention
for numerous reasons, not least
because of a variety of enlightening
research reports. The Swedish
twin study shows that genetics
plays much less of a role in the
development of Alzheimer’s
than previously thought.
In that study of identical and
non-identical twins, the siblings
of those who developed AD became
ill with the disease less than
50 percent of the time. This suggests
only a limited genetic association.
The rest of the risk appeared
to be due to lifestyle and environment.
AD might be associated with viruses,
bacteria, diet, medications, toxic
exposure, education (continuing
mental stimulation), physical
activity, and life events.
A new twin study from Duke University
also shows that the development
of AD is only partly genetic.
Researchers followed 122 twin
pairs, 69 identical and 53 fraternal.
In 40 percent of the identical
twins and 20 percent of the non-identical,
both twins developed the disease.
However, a gap of five to ten
years occured from the onset in
one twin before the other was
diagnosed. This also indicates
that something other than genetics
is playing a role in AD.
This information is encouraging,
because it means that we do not
have to be resigned to our “genetic
fate,” since so many other
factors, over which we have some
measure of control, influence
our risk of having Alzheimer’s
later in life. Making the right
choices can protect the brain.
In another large study, evaluation
of over 5000 patients who have
had coronary artery bypass surgery
compared to 4000 who have had
balloon angioplasty showed that
AD risk is 70 percent higher after
bypass than after angioplasty.
This risk is relatively small,
but many bypass operations are
done when they are not clearly
needed, and in those cases the
risk is unnecessary.
A Finnish study of 1500 elderly
people shows that obesity in middle
age doubled the risk of developing
AD in later life, compared to
those who were normal weight.
This risk was further increased
if they also had high cholesterol
levels and high blood pressure,
so that those with all three had
six times the risk of AD.
Active lifestyles appear to help
preserve brain function. In a
recent review, lifestyle activities
that challenge the brain, such
as crossword puzzles, reading
(I knew this newsletter was valuable),
and both physical and mental games
reduce the risk of cognitive decline.
Social integration is part of
the complete picture of lifestyle
protecting against AD and other
degenerative diseases.
In addition, diet plays a role
in protecting against brain degeneration.
A study of 13,000 women showed
that those who consumed more green
vegetables, such as spinach and
broccoli, in mid-life had better
cognitive function as they aged
than those women who consumed
few vegetables. In addition, in
an animal model of AD, blueberries
were helpful in reducing the brain
changes associated with the disease.
Increasing consumption of omega-3
oils (EPA and DHA) from fatty
fish, such as wild salmon or sardines,
reduces age-related loss of cognitive
function. A study of 1613 subjects
from 45 to 70 years old showed
a significant direct relationship
with brain function. Higher consumption
of cholesterol and saturated fat,
conversely, was associated with
a decrease in cognitive ability.
The Nurses’ Health Study,
evaluating over 120,000 nurses,
showed that taking estrogens (Premarin)
with or without medroxyprogesterone
(Provera) did not help to improve
mental function, but was instead
associated with some decline.
This is not the same as taking
bio-identical hormones, which
mimic the same hormone balance
that occurs naturally in the body.
Dietary supplements may also
help with preventing and reversing
dementias, such as alpha-lipoic
acid, acetyl L-carnitine, ginkgo
biloba, vitamins C and E, coenzyme
Q10, and curcumin. I presented
this information in the February
issue of Healthy Living.
The Mediterranean diet is known
for its association with a relatively
low risk of cardiovascular disease
(although not as low as the Asian
diet). Recent information suggests
that part of the benefit of the
diet is due to reduction of inflammation
and the level of blood clotting
factors in the serum.
This diet is high in vegetables,
fruits, beans, and fish, and low
in meat, dairy products, and saturated
fats. The study of 3042 subjects
in Greece showed that those who
adhered most closely to the diet
had lower levels of the inflammatory
marker CRP (C-reactive protein),
the cardiac risk factor homocysteine,
and fibrinogen, a clotting factor
associated with cardiac risk.
Another source of omega-3 oils
is flaxseeds. the seeds are excellent
sources of fiber and phyto-estrogenic
lignans. About 60 percent of these
seeds is oil, and half of that
is the omega-3, alpha linolenic
acid. Research suggests that this
oil can reduce some serum markers
of inflammation and decrease glucose
absorption after meals (this would
help to lower insulin production
and reduce metabolic syndrome
risks).
A dietary review of 4900 adults
showed that higher dietary fiber
intake was associated with a lower
serum level of CRP. This may be
due to the presence of fiber in
foods that are high in phytochemicals
and antioxidants. The same authors
found that increasing saturated
fat consumption was associated
with higher levels of CRP. Animal
products are the primary sources
of saturated fats in the Western
diet.
Trans fats are also associated
with more inflammation markers.
Trans fats are present in hydrogenated
oils such as margarines and shortening,
as found in many processed foods.
In the Nurses’ Health Study,
inflammatory markers were studied
in relation to trans fat intake
in 823 women. These markers were
elevated with higher trans fat
consumption, particularly in women
with higher body mass index.
Q. Are niacinamide
and inositol hexaniacinate free
of side effects, and does the
latter have all the benefits of
niacin?
--CT, Spain, via Internet
A. Vitamin B3
comes in three forms, niacin (or
nicotinic acid), niacinamide,
and inositol hexaniacinate, sometimes
called a “non-flush”
niacin. It is essential for metabolism
of carbohydrates, fat, and alcohol,
and for maintaining normal brain,
skin, and digestive function.
In addition, high doses of either
niacin or inositol hexaniacinate
(but not niacinamide) help to
lower cholesterol and triglycerides,
raise HDL levels, and improve
circulation to the legs in vascular
disease. Niacin may cause a temporary
skin flush due to histamine release,
and high doses may raise uric
acid levels and liver function
tests, while the timed-release
form has rarely caused some reversible
cases of hepatitis. Inositol hexaniacinate
and niacinamide do not have these
side effects. Some psychiatric
patients may respond better to
niacin or niacinamide.
Typical doses of B3 range from
50 to 200 mg in a basic multiple
vitamin, up to 3000 mg for management
of mental illness, high cholesterol,
heart disease, and peripheral
vascular disease. It may be even
more helpful for cholesterol when
combined with other supplements,
such as policosanol, garlic, chromium,
red yeast rice, gugulipids, or
pantethine.
Occasional side effects (acid
indigestion, headache) are not
seen with inositol hexaniacinate.
These supplements are better for
cardiovascular disease, and much
safer than medications, for lowering
cholesterol, and have other benefits.
Pedersen NL,
et al., How heritable is Alzheimer’s
disease late in life? Findings
from Swedish twins. Ann Neurol.
2004 Feb;55(2):180-5.
Plassman BL,
The 9th International Conference
on Alzheimer’s Disease and
Related Disorders (ICAD). July,
2004.
Wolozin B,
The 9th International Conference
on Alzheimer’s Disease and
Related Disorders (ICAD). July,
2004.
Gustafson D,
et al., An 18-year follow-up of
overweight and risk of Alzheimer
disease. Arch Intern Med. 2003
Jul 14;163(13):1524-8.
Fratiglioni
L, et al., An active and socially
integrated lifestyle... against
dementia. Lancet Neurol. 2004
Jun;3(6):343-53.
Wilson RS,
et al., Participation in cognitively
stimulating activities and risk
of incident Alzheimer disease.
JAMA 2002 Feb 13;287(6):742-8.
Kalmijn S,
et al., Dietary intake of fatty
acids and fish in relation to
cognitive performance at middle
age. Neurology. 2004 Jan 27;62(2):275-80.
Kang JH, et
al., Postmenopausal hormone therapy
and risk of cognitive decline
in community-dwelling aging women
Neurology. 2004 Jul 13;63(1):101-7.
Chrysohoou
C, et al., ...Mediterranean diet
attenuates inflammation and coagulation....
J Am Coll Cardiol. 2004 Jul 7;44(1):152-8.
Bloedon LT,
Szapary PO, Flaxseed and cardiovascular
risk. Nutr Rev. 2004 Jan;62(1):18-27.
King DE, et
al., Relation of dietary fat and
fiber to elevation of C-reactive
protein. Am J Cardiol. 2003 Dec
1;92(11):1335-9.
Mozaffarian
D, et al., Dietary intake of trans
fatty acids and systemic inflammation
in women. Am J Clin Nutr. 2004
Apr;79(4):606-12.
Malik S, Kashyap
ML, Niacin, lipids, and heart
disease. Curr Cardiol Rep. 2003
Nov;5(6):470-6.
Rosenson RS,
Antiatherothrombotic effects of
nicotinic acid. Atherosclerosis.
2003 Nov; 171(1): 87-96.
Monograph (no
authors listed), Inositol hexaniacinate.
Altern Med Rev. 1998 Jun;3(3):222-3.
The most common non-prescription
medications for children with
coughs and disrupted sleep due
to colds (DM, or dextromethorphan,
and diphenhydramine, or Benadryl)
were compared with placebo in
a controlled study of 100 children
with upper respiratory infections.
Researchers found that the drugs
were ineffective. The kids improved
on the second night of the study
whether they were on the medications
or placebo. DM caused more insomnia,
and diphenhydramine caused more
drowsiness than placebo (Paul
IM, et al., Effect of dextromethorphan,
diphenhydramine, and placebo on
nocturnal cough and sleep quality
for coughing children and their
parents. Pediatrics. 2004 Jul;114(1):E85-90).
Glucosamine sulfate (GS) and
methylsulfonyl methane (MSM) both
help osteoarthritis, but combining
them is even better (Usha PR.
Naidu M.UR, Randomised, Double-Blind...Study
of Oral [GS], [MSM] and their
Combination in Osteoarthritis.
Clinical Drug Investigation, 2004,
24(6):353-363). Researchers treated
18 patients for 12 weeks, and
found that the combination of
1500 mg of each supplement was
more effective than either alone.
GS lowered the pain score from
1.74 to 0.65, MSM lowered it from
1.53 to 0.74, but the combination
reduced it from 1.7 to 0.36, and
also worked faster.
Eating fish containing omega-3
oils, baked or broiled, but not
fried, can reduce the risk of
developing atrial fibrillation
(AF), a common cardiac arrhythmia
(Mozaffarian D, et al., Fish intake
and risk of incident atrial fibrillation.
Circulation. 2004 Jul 27;110(4):368-73).
Following 4815 adults, researchers
found a 28 percent reduction in
the incidence of AF in people
who ate fish 1 to 4 times a week,
and a 31 percent drop with 5 or
more servings, compared to those
who consumed it less than once
a month. It is important to choose
wild fish with low toxin levels.
Salmon (wild, not farmed) is
one of the best sources of omega-3
oils. You can easily cut it into
chunks and skewer them, alternating
with chunks of bell peppers, mushrooms,
tomatoes, zucchini, summer squash,
and onions. I sprinkle this with
ground pepper, thyme, ginger,
lemon, and crushed garlic. Place
the skewer inside a fish grilling
basket to make turning easier.
I like to mince fresh basil and
put some on the fish near the
end of cooking, and then serve
with another sprinkle of fresh
lemon. You can also do the same
vegetables on the side. One way
I learned from friends is to sear
them on a griddle with some sesame
and sunflower seeds until the
seeds are toasty and aromatic.
You can serve this with some fresh
corn on the cob, whole-grain garlic
bread, soba noodles, or brown
rice. For vegetarians, you can
substitute tofu for the salmon
chunks.
