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Fooled by Fad Diets
Prevent and Treat Dementias
Lifestyle and Dementias
Supplements for Dementias
Ask Dr. J: Crohn's Disease
References
In the Health News
Diet and Disease
Recipe of the Month: Hearty Three-Bean Soup
Dear Friends,
Don’t be fooled by fad diets, no matter how long they
have been around nor how much popular press they receive.
What you need to protect your health and prevent chronic disease
and suffering is legitimate, reproducible, scientific evidence
for any proposed diet guideline. The high-protein/fat diets
that have been proposed for weight loss fail on these issues
(as well as weight loss).
I am concerned that fast food establishments are now putting
the Atkins logo on what they call “low carb” products.
All this means is that you can now get low-carb junk with
all of the other junk that they sell. This is not to say that
you can’t lose weight on high protein diets. You can,
possibly because eating a high proportion of protein and fat
curbs the appetite.
However, the evidence is pretty clear that these fad diets
(whether the Zone, Blood Type, or No-Grain diets), all too
high in protein and fat, do not lead to long-term weight loss
or health. Reports are consistent that whole grains, complex
carbohydrates, fresh fruits, vegetables, beans, seeds, nuts,
and uncontaminated fish are the healthiest dietary choices.
In addition, proponents of low carbohydrate diets mislead
people into thinking that all carbohydrates are the same,
lumping simple refined sugar and white flour with complex
carbohydrates from whole grains (whole wheat, oatmeal, and
brown rice for examples), beans, squashes, and potatoes. The
effect of complex carbohydrates on physiology is not the same
as a donut!
Some of the proponents of high protein diets insist that
high carb diets always lead to diabetes and insulin resistance
(a risk factor for heart disease). They fail to explain the
fact that on primitive diets, such as the native African or
Asian diets, which are very high in unrefined carbohydrates,
obesity and diabetes are rare, or the scientific research
showing that whole grains reduce insulin resistance.
The recent studies in the New England Journal of Medicine
that I reported on briefly in June were popularly reported
as supporting the Atkins diet for weight loss (though it said
nothing about the long-term consequences). However, even for
weight loss, the differences between the Atkins diet and what
they called a low-fat diet were small, and short-lived.
People had trouble staying on any of the diets, but those
on the low-carbohydrate diets had more difficulty than the
others. More of them dropped out and strayed from the diet
than in the other group. In addition, and most importantly,
the risk of heart disease, cancer, diabetes, stroke, hypertension
and other diseases is lower with mostly vegetarian choices.
I write about this a lot because it is one of the areas in
which the public is misled, and in which many of my colleagues
lose their scientific perspective, which is so important to
maintain for those of us in integrative medicine.
A primary concern of our aging population is the increase
in the incidence of senile dementia, whether caused by atherosclerosis
of the arteries to the brain, Alzheimer’s disease (AD),
or other causes. Symptoms of Alzheimer’s include memory
loss, loss of the ability to reason, disorientation, and personality
changes, such as depression, irritability, anxiety, and agitation,
and eventual death.
Dementia is also associated with Parkinson’s disease
(PD) and, of course, Creutzfeldt-Jacob disease (CJD), also
known as “mad cow” disease. Regardless of the
cause, dementia results from damage to brain cells. With vascular
disease, brain degeneration can be the result of a sudden
large stroke, or repeated small strokes.
In AD, a substance called “amyloid” is associated
with brain cell degeneration. Amyloid is a collection of protein
fragments that clump together and deposit in the brain, inducing
free radical damage to neurons. Why amyloid is deposited is
not clear. Other protein fragments accumulate inside brain
cells and cause damage.
Researchers have developed a new radioactive dye that reveals
amyloid deposits, and this may allow an earlier diagnosis
of AD, provide the ability to follow the progression or regression
with treatment.
Dememtias progress at different rates, and may take a few
years to many years to become severe and lead to death. What
is becoming increasingly apparent is that oxidative free-radical
damage is involved in dementias, including AD and PD, but
lifestyle choices also play a role.
Dietary intake of omega-3 oils from fish is associated with
an increased ability to perform mental tasks, while cholesterol,
total fat, and saturated fat consumption are linked to decreased
brain function. High total caloric intake leads to a greater
risk of developing dementia.
Exercise is also beneficial to the brain. In a study of 5925
women over 65, the greater their physical activity level the
less likely they were to experience cognitive decline. Researchers
used blocks walked, stairs climbed, and total calories expended
to evaluate activity. Those at the highest exercise level
had a 37 percent lower risk of a decline in brain function
than those who had the least physical activity.
Leisure activities, such as playing board games or a musical
instrument, reading, and dancing are all associated with a
lower risk of dementia. A study of 469 subjects over 75, followed
for five years, showed that for each day per week of activity,
there was about 7 percent less decline of cognitive function.
(In this study exercise did not have such an effect.)
Evidence is accumulating that antioxidants help to prevent
both Alzheimer’s and Parkinson’s dementias, and
atherosclerotic brain degeneration. In an animal model, feeding
blueberry (a rich source of antioxidants) early in life prevents
cognitive decline, and can reverse age-associated brain deterioration.
In Alzheimer’s, sugar-protein complexes contribute
to oxidative damage and deposition of both amyloid and intracellular
protein tangles. This is controlled by antioxidant enzymes,
such as glutathione peroxidase, and the entire antioxidant
system requires nutrients such as vitamins C and E, alpha-lipoic
acid, and flavonoids.
Vitamin E can prevent the oxidative damage to neuronal cells
caused by amyloid. In the Nurses’ Health Study, among
15,000 participants, those who took high-dose vitamins C and
E for the longest time retained the highest level of cognitive
function compared to those with the lowest levels of intake.
This was a 15-year study, and it is apparent that long-term
use is important to get the full benefits of the supplements.
Another study of vitamins C and E showed that supplements
led to a 90 percent reduction in vascular dementia.
Most recently, a study of 4740 subjects showed that those
who were taking combined vitamins C and E were 78 percent
less likely to have AD at the start of the study. Over the
next four years, those taking the supplements were 64 percent
less likely to develop AD. The vitamin E doses ranged from
400 to 1000 IU, and vitamin C from 500 to 1500 mg.
A small, uncontrolled study of 10 patients with AD showed
that 600 mg of alpha-lipoic acid, an antioxidant, helped stop
disease progression for one year. Animal studies show that
a combination of alpha-lipoic acid and acetyl L-carnitine
reduces the oxidative damage to neurological tissues and protect
the mitochondria.
I have reported earlier that curcumin, an antioxidant extract
from the spice turmeric, prevents the accumulation of amyloid
in the brain, and it also improves cognitive function in AD
patients.
I have already reported that high daily doses of coenzyme
Q10, up to 1200 mg, can reduce the progression of Parkinson’s
disease. As an antioxidant, coQ10 is another contributor to
brain protection, and would be expected to provide protection
from dementia.
Ginkgo biloba is also helpful. In a controlled study of 244
patients for six months, 120 mg of standardized ginkgo biloba
led to a significant improvement in cognitive function, activities
of daily living, and social behavior compared to the the placebo
group, which worsened.
It is essential to provide antioxidant protection for the
brain. Proanthocyanidins and anthocyanins found in grape seeds
and skins, pine bark, and berries, are other antioxidants
that are able to cross into the brain. Research in several
tissue culture studies shows that they protect cells from
the damaging effects of amyloid, and therefore might protect
against AD.
Reducing heavy metal exposure also protects the brain. Although
the link between aluminum and AD is weak, this and other metals
(lead, mercury) damage neurons. Removing them with oral chelators
such as N-acetyl cysteine, DMSA (succinic acid), and alpha-lipoic
acid is beneficial.
Although some of the researchers who find all these benefits
from supplements will say that they do not yet have “enough
evidence” to recommend them, the safety margin is so
great that you would be unwise to wait to take them until
some researcher gives their approval.
Q: I have Crohn’s disease. What supplements
do you recommend?
— MB, Brazil, via Internet
A. Inflammatory bowel disease can be devastating,
with bloody diarrhea, abdominal pain, bloating, fever, loss
of appetite, and malabsorption of nutrients. Crohn’s
disease incidence is directly related to intake of sugar,
total fat, animal fat, meat and milk protein, and omega-6
oil (Shoda R, et al., ...fatty acids and animal protein [and]
Crohn disease in Japan. Am J Clin Nutr. 1996 May;63(5):741-5.).
Fiber and vegetable protein decrease Crohn’s incidence.
Fast foods can triple the risk! A high-fiber, complex carbohydrate
diet can help manage this disorder, but it is important to
stay away from food sensitivities, including, in many cases,
wheat and other gluten sources, and dairy products.
Supplements that help the bowel heal include the amino acid
L-glutamine (3000 to 8000 mg), vitamin C (2000 to 6000 mg),
and fish oil (with 1200 to 2400 mg of omega-3 oil). The fish
oil and vitamin C are anti-inflammatory, and the L-glutamine
is essential for the regeneration of the bowel lining cells.
Gamma linolenic acid (GLA, 240 mg) is also helpful to reduce
inflammation, as are curcumin (standardized, 300 to 600 mg),
and ginger (standardized, 500 to 750 mg).
Liese AD, et al., Whole-grain intake and
insulin sensitivity: .... Am J Clin Nutr. 2003 Nov; 78(5):
965-71.
Liu S, et al., ...dietary fiber and grain
products and ...development of obesity ... Am J Clin Nutr.
2003 Nov; 78(5): 920-7.
Kalmijn S, et al., Dietary intake of fatty
acids and fish in relation to cognitive performance... Neurology.
2004 Jan 27;62(2):275-80.
Kalmijn S, Fatty acid intake and the risk
of dementia and cognitive decline:... J Nutr Health Aging.
2000;4(4):202-7.
Laurin D, et al., Physical activity and
risk of cognitive impairment and dementia ... Arch Neurol
2001 Mar;58(3):498-504.
Joseph JA, et al., Blueberry ... prevents
behavioral deficits in an Alzheimer disease model. Nutr Neurosci.
2003 Jun;6(3):153-62.
Verghese J, et al., Leisure activities
and the risk of dementia in the elderly. N Engl J Med. 2003
Jun 19;348(25):2508-16.
Yaffe K, et al., A prospective study of
physical activity and cognitive decline in...women... Arch
Intern Med 2001 Jul 23;161(14):1703-8.
Munch G, et al., Anti-AGEing defences against
Alzheimer’s disease. Biochem Soc Trans. 2003 Dec; 31(Pt
6): 1397-9.
Yatin SM, et al., Vitamin E Prevents Alzheimer’s
Amyloid ..Oxidation ... J Alzheimers Dis 2000 Jun;2(2):123-131.
Masaki KH, et al., Association of vitamin
E and C supplement use with cognitive function... Neurology
2000 Mar 28;54(6):1265-72.
Zandi PP, et al., Reduced risk of Alzheimer
disease in users of antioxidant vitamin supplements... Arch
Neurol. 2004 Jan;61(1):82-8.
Hager K, et al., Alpha-lipoic acid...for
Azheimer type dementia. Arch Gerontol Geriatr. 2001 Jun;32(3):275-282.
Liu J, et al., Memory loss...reversal by
feeding acetyl-L-carnitine and/or...lipoic acid. Proc Natl
Acad Sci U S A 2002 Feb 19;99(4):2356-61.
Le Bars PL, A...controlled trial of the
ginkgo biloba extract EGb 761 in dementia. Dement Geriatr
Cogn Disord 2000 Jul-Aug;11(4):230-7.
Persson PG, et al., Diet and inflammatory
bowel disease: a case-control study. Epidemiology. 1992 Jan;3(1):47-52.
- Hospitals are no place to go for a restful vacation, as
I found out when I had surgery in March. A recent study
(Reuters, Feb 4, 2004) showed that hospital wards could
be as noisy as a rock concert, or as loud as a chain saw,
preventing patients from getting adequate sleep. Sleep is
essential for the healing process, but it is not easy to
sleep when nurses are talking, blood tests and X-rays are
being taken, or equipment is being banged around. One solution
is to close the door to the room, which will provide some
help, and politely ask the staff to be more quiet.
- The World Health Organization suggests steps to reduce
obesity in the world’s population: reducing advertising
of junk to children, and limiting sodas, other sugary foods,
salt, and fat. The food industry dislikes this publicity,
as it might affect the sales of these deleterious products.
The US government took issue with this report, siding with
the junk-food industry. They claim that “all foods”
can be part of a good diet (how Twinkies or Oreos fit in
I’ll never understand). How can government give support
to junk food and still fight obesity?
Compared to wild salmon, most farmed salmon has 40 times
the level of toxic polychlorinated biphenyls (PCB’s),
dioxin, dieldrin, chlordane, DDT, and other poisons (Hites
RA, et al., Global assessment of organic contaminants in farmed
salmon. Science. 2004 Jan 9;303(5655):226-9). Researchers
took samples from 16 cities in Europe and America and found
that contamination was widely distributed. The benefits of
omega-3 fish oils are worthwhile, so be sure to choose wild
salmon. (Alaska does not permit fish farming, but most fish
at the market is farmed.)
The cold northeast winter calls for a hearty (and heart healthy)
soup that is easy and delicious. After soaking for 4 to 8
hours, discard the soaking water (to diminish intestinal gas),
and pressure cook a combination of chick peas, black beans,
and pinto beans for about 25 minutes (or cook until soft in
a large pot). Sauté onions and garlic in olive oil,
with cumin, cayenne pepper, thyme, and diced carrots and celery
stalks with the leaves. Put this mix into the bean pot with
enough water to make it soup rather than stew (although either
will be fine) and add chopped Swiss chard or spinach and a
small amount of soy sauce. I prefer more veggies than beans,
and I add a large can or two of organic, Muir Glen Fire-Roasted
tomatoes, but this depends on your taste. Simmer all this
until the flavors are well mixed, and serve with whole wheat
bread.
drjanson@drjanson.com
November
through May: 386-409-7747
June
through October: 603-878-2256
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