Diet and Alzheimer’s Disease

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What weighs a mere four pounds and has a workload that demands 20 percent of all the oxygen inhaled?  Answer:  the human brain.

As technology opens the door to the unique metabolic functions of the brain, scientists are investigating the nutrients required to keep mentally sharp over the decades.

With dementia rising at an alarming rate — along with obesity, diabetes, heart disease, and other ailments — let’s eat with purpose, using sound, nutrition-related science applicable to the brain and the rest of the body.

Starting with the belief that what we eat plays a significant role in determining who gets dementia, Martha Clare Morris, Ph.D. and colleagues developed the MIND Diet as an intervention against the most common cause of neurodegeneration:  Alzheimer’s disease.

The work of Morris and her colleagues is based on research completed at Rush Medical University in Chicago, Illinois.  The term “MIND” is an acronym for Mediterranean-DASH Intervention for Neurodegenerative Delay.

The DASH diet plan is based on research sponsored by the U.S. National Institutes of Health.  The plan was developed to lower blood pressure without the use of medication.

The Mediterranean and DASH diets are models of healthy eating for the body.  The Morris team chose foods that improve brain function significantly and also added to overall body wellness.

Adherence to the MIND diet may lower the risk of Alzheimer’s disease by as much as 53%, offering more protection for the brain than any other dietary regimen.

The MIND cuisine lists 10 brain-healthy food groups (green leafy vegetables, other vegetables, nuts, berries, beans, whole grains, fish, poultry, olive oil, and wine).  The plan limits consumption of five brain-unhealthy food groups (red meats, butter/stick margarine, cheese, pastries/sweets, and fried or fast food).

The plan suggests a minimum of three servings of whole grains, a salad, and one other vegetable every day — along with a glass of wine.  For snacks, add a variety of nuts.  Berries are the only fruits recommended.

Specifically, blueberries are noted as the powerful protectors of the brain.  Strawberries are a second choice for good cognitive function.

Use Google and enter the term “MIND Diet” for daily guidelines and recipes of a cuisine designed to maximize brain function while providing healthy foods for the rest of the body as well.

Dr. Laura Pawlak (Ph.D., R.D. emerita) is a world-renown biochemist and dietitian emerita.  She is the author of many scientific publications and has written such best-selling books as “The Hungry Brain,” “Life Without Diets,” and “Stop Gaining Weight.”  On the subjects of nutrition and brain science, she gives talks internationally.

 

Influenza

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By Raj Hullon, M.D., J.D.

The flu is a contagious infection that affects the nose, throat, and lungs.  Onset is more abrupt compared to the common cold.  Symptoms can range from mild to severe, even leading to life-threatening complications.  Nausea, vomiting, and diarrhea are more common in children than in adults.  Other flu symptoms include:

  • fever (usually high).
  • extreme fatigue.
  • dry cough.
  • sore throat.
  • nasal congestion or runny nose.
  • muscle aches.
  • impaired sense of taste and smell.
  • loss of appetite.

Although flu-related morbidity and mortality vary from year to year, the CDC estimates that between five and 20 percent of Americans contract flu in a given year and that 200,000 people are hospitalized for treatment of flu-related complications.  Approximately 36,000 deaths a year result from flu-related causes in the United States (cdc.gov).

Seasonal flu refers to any of the combinations of influenza viruses that circulate throughout the world each year.  The flu season in the United States can begin as early as October and run through March.  The Center for Disease Control (CDC) tracks circulating flu viruses and related disease activity all year and, between October and May, provides weekly influenza updates at http://www.cdc.gov/flu/weekly/fluactivitysurv.htm.   Pandemic flu refers to a global outbreak of flu that can overwhelm the health care system.  The cause is most likely a strain of influenza virus that is new or that has not circulated recently enough for large portions of affected populations to have built up gradual immunity to it.  Therefore, healthy individuals are at risk for complications following infection during a pandemic flu outbreak.  Seasonal flu, however, usually leads to fewer complications in healthy adults.  During the 1918 pandemic, for example, the estimated deaths from the disease and disease-related complications reached 20 to 40 million individuals globally. Fortunately, pandemic flu outbreaks are rare.  There were only three pandemic outbreaks in the 20th century while seasonal flu is annual and peaks in January or February.

Arthritis and Diet

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older-black-woman-rubbing-her-hands-arthritisThere are more than 100 different types of arthritis, and, therefore, no single diet will work for every person with arthritis.  However, studies have found that green tea, green leafy vegetables, dried plums, and kiwi fruit are all vitamin-rich and have powerful antioxidant properties.  Diets which include large quantities of fruits and cruciferous vegetables have been shown to have a beneficial effect on preventing the development of rheumatoid arthritis.  In addition, it is clear that carrying extra weight can put significant stress on the joints, and even a small reduction in weight can have an effect on the severity of arthritis symptoms.  Studies have shown that losing weight can significantly ameliorate the effects of osteoarthritis.  Significant weight gain prior to age 35 — as well as excessive alcohol consumption — has been linked to the development of gout.

Other contributing factors are certain foods and nutritional supplements (vitamins, minerals, and omega-3 fatty acids) which may play a role in preventing and reducing symptoms in some types of arthritis, such as gout, osteoporosis, osteoarthritis, rheumatoid arthritis (RA), and reactive arthritis.  Fish oil, particularly when ingested in conjunction with a diet low in arachidonic acid, reduces inflammation in some patients with rheumatoid arthritis.   Regular intake of fish has been shown to have a beneficial effect.  Consumption of excessive dietary fat, however, appears to exacerbate arthritis symptoms.

WEIGHT LOSS AND THE ARTHRITIS PATIENT

Weight loss for overweight arthritis patients is very important for several reasons.  First, as mentioned previously, loss of even a few pounds can significantly reduce stress on weight-bearing joints.   Research demonstrates that exercise and combined weight loss — as well as exercise regimens — result in decreased pain and disability and increased performance levels in patients with osteoarthritis.  Biomechanical data suggest that exercise in combination with diet may also result in improved gait when compared with exercise alone. Secondly, patients of all ages who have arthritis are much healthier, have an improved sense of well-being, and are less likely to suffer arthritis-related depression when they follow a nutritious, well-balanced diet.  The Arthritis Foundation recommends following a balanced diet that includes plenty of fruit, vegetables, and whole-grain products, while limiting consumption of sugar, salt, and saturated fat (i.e., a diet low in fat, high in fiber, and low in sugar).

By Mary O’Brien, MD

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Neck Pain: An Introduction

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Rear view of a young man holding her neck in pain, isolated on white background, monochrome photo with red as a symbol for the hardening

Almost everyone has experienced neck pain of some sort during his or her lifetime — and for good reason.  One of the most common causes of such pain is poor posture.  Simple activities such as reading, especially in bed — or sleeping on a pillow that may either be too low or too high — can cause neck pain.  Other activities that can cause neck pain include bending over a desk for hours, maintaining poor posture while watching TV, and positioning a computer monitor either too high or too low.  The key is always to maintain the neck as close to a neutral position as possible.

The best medical care, however, begins with a crucial question:  What is the most serious problem this could be?  Neck pain can be referred from multiple anatomical structures as a result of developmental processes in the embryonic stage.  Serious cardiovascular, neurologic, infectious, or neoplastic etiologies must be considered before attention is focused on common musculoskeletal disorders.

Chronic neck pain is prevalent in Western societies, with about 15 percent of women and 10 percent of men suffering from it at any given time.  People with physically demanding jobs requiring neck flexion and awkward lifting are at high risk of developing chronic neck pain.  It is also common among health care professionals, particularly affecting nurses who are constantly involved in handling tasks that involve reaching, lifting, and pulling.  Dental professionals who work long hours bending over their patients also suffer from neck pain because of postural demands.

The pain is often muscular or ligamentous in origin and is usually self-limited although the pain can be persistent.  Pain is transmitted through nerve endings in the various ligaments and muscles of the neck, vertebral joints, and the outer layer of the intervertebral discs.  When these structures are irritated, strained, or inflamed, pain is felt in the back of the neck, may spread toward the shoulders, and is commonly felt between the shoulder blades.

The natural healing processes result in improvement in almost all cases.  In fact, the pain from serious neck injuries such as fractures, dislocations, and most cervical spine surgeries often resolves after a few weeks or months.  There is usually little if any correlation between neck pain and the degenerative changes that are commonly seen on X-rays.

Neck strain or sprain is the most common type of injury to motor vehicle occupants treated in U.S. hospital emergency departments.  Whiplash injuries can be serious in certain situations.  Severe damage to the spinal cord can be fatal.

Sports and athletics are also common sources of injury to the neck region and should be a particular concern for the younger adult population.

Another common offender is carrying unbalanced loads, such as a heavy briefcase, luggage, or a shopping bag. A careful history is often required to identify such factors as playing a role in neck and shoulder pain.

By Rajinder Hullon, MD

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About Systemic Lupus Erythematosus (SLE)

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bhmkclteeodsgq5wrqwaSystemic lupus erythematosus (SLE) is an autoimmune disease that can cause damage to the heart, lungs, kidneys, joints, skin, brain, and blood vessels.   It is characterized by flare-ups, and symptoms, ranging from mild to severe, including extreme fatigue, chest pain, anemia, swelling in legs and near the eyes, painful joints, fever, skin rashes, hair loss, and kidney problems.

At least 1.5 million Americans suffer from lupus.  The ratio of female to male is 9:1 according to the Lupus Foundation of America.   African-American women are far more likely to be affected than are Caucasian women.   Recent research points to a strong genetic role, but environmental and hormonal factors seem to be involved in lupus as well.

Diagnosis can be difficult and may be delayed because the onset of symptoms is hard for patients to pinpoint and because the wide variety of symptoms overlap with many other conditions.  To diagnose lupus, the clinician takes a careful history, performs a physical exam, and orders anti-nuclear antibodies and other laboratory tests.

Although lupus can be life-threatening, some 80 to 90 percent of sufferers can expect to live a normal lifespan if they are carefully monitored and treated.

Management of lupus is directed at preventing flare-ups, treating symptoms, and preventing or slowing damage to organs.  According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the principal medications include:

  • NSAIDs to reduce inflammation.
  • Anti-malarials such as hydroxychloroquine (Plaquenil®) to prevent flare-ups.
  • Corticosteroids such as prednisone (Deltasone®), hydrocortisone, methylprednisolone (Medrol®), and dexamethasone (Decadron®, Hexadrol®) to reduce inflammation.
  • Immunosuppressive agents such as cyclophosphamide (Cytoxan®) and mycophenolate mofetil (CellCept®) to inhibit an overactive immune system.  Belimumab (Benlysta®) is a B-lymphocyte stimulator protein inhibitor that was approved by FDA 2011 for patients with lupus who are receiving other standard therapies.  It may reduce the number of abnormal B cells thought to be a problem in lupus.
  • Methotrexate (Folex®, Mexate®, Rheumatrex®), a disease-modifying antirheumatic drug, may be used to help control the disease in some patients.

Other treatments may include hormonal therapies such as dehydroepiandrosterone (DHEA) and intravenous immunoglobulin, which may be useful for controlling lupus when other treatments haven’t worked.

A variety of self-care and complementary approaches can be useful, including exercise, diet, the avoidance of sun exposure, and skin protection.  Patients are advised to recognize early signs of a flare-up and get immediate medical attention.

Findings from prospective human studies have strengthened the evidence of a connection between lupus and vitamin D status.  There is evidence that increased vitamin D levels (via supplementation) may help reduce inflammation.  A reasonable dose would be 2000 IU of vitamin D3 on a daily basis.  Vitamin D levels are easily checked.

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Horses as Therapeutic Animals

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horse-1330690_640By Barbara Sternberg, Ph.D.

Hippotherapy is the technical term for therapy with horses. While it has been around for more than a century, hippotherapy came to the fore when a woman named Liz Harwell, whose legs were essentially paralyzed by polio, won the Silver Medal in dressage at the 1952 Helsinki Olympic Games. Today, half a century later, hippotherapy programs are ongoing in multiple countries, and therapeutic riding programs have been developed for people with physical, psychological, cognitive, social, and behavioral problems including cerebral palsy, spina bifida, mental retardation, and depression. The North American Riding for the Handicapped Association makes a distinction between hippotherapy, or horse-based physical therapy under the direction of a licensed therapist, and therapeutic riding, which utilizes different methods to improve strength, muscle control, eye-hand coordination, and social skills.

Riding a horse involves what physical therapists refer to as three-dimensional movement. With each step, the person’s pelvis tilts up, sideways and forward, and back. The horse repeats the sequence and the sensation of these bodily motions for people with physical or neurological handicaps, reacquainting their muscles with how they are supposed to move. The pressure of the horse’s hooves hitting the ground is also three-dimensional, and stimulates the rider’s knees, hips, and spine. It is believed that this movement stimulates the brain, directly affecting the nervous system.

Even speech and language therapy can be enhanced by therapeutic riding programs. Ruth Dismuke-Blakely, a speech therapist from New Mexico, has been working with patients on horseback since 1981. She believes that most speech therapy addresses only the mouth and the brain, disconnected from the rest of the body, but that in fact, the rest of the body is very important for speech. Horses, with their well organized neurological systems, “lend their ordered system to a disordered one.”

Other speech therapists also find horseback riding a therapeutic venue in which to conduct treatment because patients learn more quickly when engaged in real-life settings than when in an office. Hippotherapy is actually approved by the American Speech and Hearing Association as a therapeutic modality.

Psychotherapy takes place in the realm of horses, too, specifically in the stall, along with the horse, the patient, and the therapist. According to psychotherapist Marilyn Sokoloff, PhD the additional aspect of having a horse to touch and interact with speeds up the pace of psychotherapy. The human-horse interaction gives the therapy a here-and-now component to analyze that can cut through resistances that have hindered progress for years. Sokoloff has used horses in group therapy sessions with women, convening the sessions in a horse barn with the women seated in chairs in a circle and the horses in their stalls all around them. Physical contact with the horses is encouraged as a mode of putting the women in touch with their feelings. These women suffer from depression, anxiety, eating disorders, and physical and sexual abuse and are challenged by the horses to find new ways of control. Getting a horse to do what you want raises issues of power and control which are confronted by the women in the group, often to powerful effect.

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Food, Calcium, and Bone Health

Posted on Posted in Continuing Education, Elder Care, Homestudy, Nutrition

CalciumFoods_ML1512_ts481492527By Barbara Boughton

Once a woman hits menopause, getting enough calcium for bone health becomes a major concern. Women over age 60 are prone to osteoporosis — and the spinal, hip, and knee fractures that osteoporosis can bring. Yet adequate dietary calcium can help protect people from osteoporosis.  Taking calcium supplements can help as well.

It’s not just menopausal women who should be concerned about getting enough calcium. As consumption of sugary soft drinks has risen among children and teenagers, intake of milk has also declined. But children and teenagers who are able to eat and drink enough calcium-enriched foods—as well as take in sufficient protein during meals—benefit from improved skeletal growth and bone mass. In fact, studies show that children who avoid, for prolonged periods, drinking calcium-containing milk have an almost three-fold higher risk for fracture than age-matched birth cohorts.

Dairy products are considered to be the easiest and cheapest sources of dietary calcium. Most people should have three to four servings of milk products daily in order to improve bone health and prevent osteoporosis. Studies have estimated that increasing dairy intake to three to four servings per day can reduce osteoporosis-related healthcare costs in the U.S. by $3.5 billion per year.

As well as calcium, it’s important to get enough calcium to enhance calcium absorption. What are your calcium and vitamin D requirements? Adults up to age 50 should get 1,000 mg of calcium and 200 International Units (IUs) of Vitamin D. Those over age 50, should intake at least 1,200 mg of calcium and 400 to 600 IUs of vitamin D each day.

Among foods with calcium, some are better than others for bone health. Yogurt is one of the best. It contains a hefty dose of calcium (415 mg per serving of plain, low-fat or non-fat per eight-ounce serving).  Many varieties of yogurt are also fortified with vitamin D. Some brands of fat-free, plain yogurt contain 30 percent of the adult daily requirements for calcium and 20 percent of the adult daily requirements for vitamin D. Although protein-packed Greek yogurts are popular right now—because of their reputed health benefits—they are less useful than other yogurt types for staving off osteoporosis. Greek yogurts contain less calcium than other types of yogurt and very little vitamin D.

Besides dairy products — such as low-fat and non-fat milk, yogurt, and cheese — there are other foods that are good for your bones. Canned sardines and salmon are rich sources of calcium, and fatty fish such as salmon, mackerel, tuna, and sardines are also replete with vitamin D. Some vegetables contain a generous amount of calcium, including collard greens, turnip greens, kale, okra, Chinese cabbage, dandelion greens, mustard greens, and broccoli. Foods fortified with calcium and vitamin D—such as some juices, breakfast foods, soy milk, rice milk, cereals, and breads—can also add to the health of your bones.

The foods with the highest amounts of calcium are:  plain low-fat yogurt; calcium-fortified orange juice; low-fat fruit yogurt; skim mozzarella cheese and cheddar cheese; canned sardines; reduced and nonfat milk; tofu made with calcium sulfate; fortified breakfast drinks; and calcium-fortified cereals. Vegetables that are the richest sources of calcium include turnip greens, kale, and Chinese cabbage. For those who are lactose-intolerant, eight ounces of calcium-fortified soy milk can have from 80 mg to 500 mg of calcium.  Rice and almond calcium-fortified beverages can be good sources of calcium, too. To find out how much calcium is in these drinks, check the nutrition label on the back of these products at the grocery store.

If you want to eat for bone health, there are also some foods you should avoid. Heavy alcohol drinking (more than two drinks per day) can lead to bone loss, as can drinking more than three cups of coffee per day. Drinks high in caffeine, including coffee, tea, and caffeinated soft drinks, decrease calcium absorption and contributes to bone loss. Sodas also make it harder for the body to absorb calcium. Salty foods cause your body to lose calcium, too. To reduce the sodium in your diet, limit processed foods, canned foods, and salt added to the foods you eat each day. Aim for 2,400 mg or fewer mg of sodium per day.

Although beans contain calcium, they also are high in substances called phytates that interfere with your ability to absorb calcium. To reduce the phytate level in beans, soak them in water for several hours and cook them in fresh water. Wheat bran also contain high levels of phytates, which prevent your body from absorbing calcium. The phytates in wheat bran not only prevent the absorption of calcium in wheat bran but also prevent the absorption of calcium in foods eaten at the same time. For example, if you have milk and 100 percent wheat bran cereal together, your body can absorb some, but not all, of the calcium from the milk. The wheat bran in other foods like breads, however, is much less concentrated and unlikely to have a noticeable impact on calcium absorption.

Some vegetables with calcium can also contain ingredients called oxalates. Oxalates make it more difficult for you to absorb the calcium in vegetables. Foods with both calcium and oxalates include spinach, rhubarb, and beet greens.

As you can see, getting the right kind of calcium and the right amount of calcium from foods are not a simple matter. Yet it’s well worth the effort, since it will improve your bone health and strength—and may reduce your need for supplements.

  1. Food and Your Bones. Fact sheet. National Osteoporosis Foundation.
  2. Dietary Supplement Fact Sheet: Calcium. National Institutes of Health.
  3. Calcium: An Important Nutrient that Builds Bones. Fact Sheet. Osteoporosis Canada.
  4. Calcium, Nutrition and Bone Health. Fact Sheet. American Academy of Orthopedic Surgeons. aaos.org.
  5. Rizzoli, R. Dairy products, yogurts and bone health. Am J Clin. 2014; 99 (suppl): 1256S-62S.

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Stress: The Silent Stalker of the Heart

Posted on Posted in Continuing Education, Elder Care, Homestudy, Pain, Seminars, Webinars

heart-915562_640Despite the many advantages of today’s technological progress, chronic stress persists as a major problem. Stress is not only uncomfortable, it can cause major damage to the circulatory and immune systems, leading to hypertension, arrhythmias, increased coagulation, and atherosclerosis.

Stress also exacerbates coronary heart disease (CHD), myocardial infarction (MI), and heart failure. Various stressors have been found to raise the risk of heart disease and even increased mortality due to heart disease—especially chronic work-related stress, marital strain, bereavement, and social isolation. Acute emotional stress may trigger myocardial infarction and a phenomenon known as stress myocarditis.

Stress, by virtue of its effects on adrenaline release, triggers myocardial ischemia, promotes arrhythmogenesis, stimulates platelet function, and increases blood viscosity. In some individuals, the intrinsic effects of stress include exaggerated heart rates and blood pressure responses. Emotions that often come with stress, namely anger, hostility, anxiety, and depression, bring a heightened risk of cardiovascular disease, coronary heart disease, and cardiac events, and — in those with heart disease — poor prognosis.

Depression is related to greater risk for developing coronary heart disease (CHD), poor prognosis in CHD, and higher mortality in those with CHD. It is also associated with arrhythmias, higher risk of acute coronary syndrome, and poor prognosis after myocardial infarction.

Those who are depressed are less likely to make lifestyle changes important for heart health. Mood disorders such as depression and anxiety may also affect lipid metabolism. Twenty percent of individuals who have cardiovascular disease or a previous history of MI have been found to have major depressive disorder (MDD). Psychosocial stressors can be both a cause and a consequence of cardiovascular disease events. Stress management might reduce future cardiac events in patients with cardiovascular disease.

Unless medications are required, patients can often make lifestyle changes that markedly decrease chronic stress. Some recommended strategies include:

  1. exercising on a regular basis.
  2. meditating for one or two 20- to 30-minute sessions a day. Studies show meditation can have lasting effects on blood pressure and heart rate.
  3. taking a vacation or a long weekend off.
  4. writing about stressful events.
  5. participating in a support group.
  6. regularly doing deep breathing exercises.
  7. using progressive muscle relaxation, which reduces muscle tension by relaxing individual muscle groups.
  8. practicing yoga, tai chi, or qi gong, all forms of exercise and meditation that are effective in reducing stress.
  9. spending more time outdoors.
  10. disconnecting from electronics and social media.
  11. listening to soothing music or silence.
  12. engaging in creative endeavors or hobbies.

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Alzheimer’s Disease

Posted on Posted in Brain Science, Continuing Education, Elder Care, Seminars

constant-63613_640Alzheimer’s disease is one of the most dreaded health conditions of our time. There is no cure, and current treatments don’t slow down the disease; they can only alleviate symptoms. As well as avoiding Alzheimer’s disease and age-related cognitive decline, many people want to stay as sharp as possible as they age, and, if possible, delay age-related cognitive decline. Yet are there truly preventive strategies to stave off of Alzheimer’s disease or cognitive problems associated with aging?

While there’s no definitive evidence about what can prevent or reduce the risk of Alzheimer’s disease or dementia, scientific studies have offered clues about strategies that might slow down or prevent cognitive decline. The good news is that research on the prevention and treatment of Alzheimer’s disease—which currently affect about 5.3 million Americans—is now a high priority.

In late 2015, the U.S. Congress approved the largest increase to date in federal spending for Alzheimer’s disease research and care-giver support in the 2016 federal budget—a $350 million increase over 2015. The increase in federal spending came in response to reports and studies documenting the needs and opportunities that lie ahead for Alzheimer’s disease research. By 2050, Medicare spending on Alzheimer’s disease is expected to quadruple to $589 billion annually, but one treatment delaying the onset of the disease could save Medicare $345 billion in the first 10 years of its use, according to a report from the Alzheimer’s Association.

Over the past 30 years, many advances have been made in understanding Alzheimer’s disease and dementia. We now understand the biology of Alzheimer’s disease as never before. The brains of people with Alzheimer’s disease are filled with amyloid plaques—composed of deposits of a toxic protein fragment called beta-amyloid. The brains of Alzheimer’s disease patients also have an abundance of neurofibrillary tangles or abnormal collections of twisted protein threads found inside nerve cells, composed chiefly of a protein called tau.  In Alzheimer’s disease, the amyloid plaques and neurofibrillary tangles damage the brain’s neurons, interfering with their ability to function and communicate with one another. As a result, Alzheimer’s disease causes the brain to shrink and atrophy.

Scientists are now emphasizing research on the development of Alzheimer’s disease and on the symptoms and signs of early Alzheimer’s disease, which is termed mild cognitive impairment. The hope is that learning more about mild cognitive impairment can help identify patients at increased risk for the disease and for disease progression.

The symptoms of mild Alzheimer’s disease include:

  • Memory loss and confusion about once familiar things or places.
  • Difficulty accomplishing daily tasks, especially handling money and paying bills.
  • Poor judgment that leads to bad decisions.
  • Mood and personality changes, such as increased anxiety and aggression.

The symptoms of moderate Alzheimer’s are more serious, and include:

  • Increasing memory loss and confusion, and shortened attention span.
  • Irritability and Inappropriate outbursts of anger.
  • Difficulty with language (in reading and writing) and difficulty in working with numbers.
  • Trouble recognizing friends and family members.
  • Difficulty organizing, planning, and thinking logically.
  • Restlessness, agitation, anxiety, tearfulness, and wandering.
  • Repetitive movements and statements and sometimes muscle twitches.
  • Paranoia, delusions, and hallucinations.
  • Loss of control over impulses.

Age and genetics are the strongest risk factors for dementia and Alzheimer’s disease. However, other risk factors have been linked to Alzheimer’s disease. Research has shown that people with heart disease, stroke, and high blood pressure may be more likely to develop Alzheimer’s disease and to have more severe diseases.  Studies also show that patients with metabolic syndrome, Type 2 diabetes, and sleep apnea are at increased risk for mild cognitive impairment and Alzheimer’s disease. Whether or not successful treatment of hypertension, heart disease, diabetes and sleep apnea can affect cognitive decline is open to question, but is under study. One large trial funded by the National Institutes of Health (NIH) has compared intensive glucose-lowering treatment with standard treatment for Type 2 diabetes, but there were no significant differences between the two groups.

Hormones such as estrogen and progesterone also have effects on the brain. Yet studies on whether menopausal hormone therapy is protective against cognitive decline or Alzheimer’s disease have been conflicting.  Research is continuing on estrogen and progesterone as well as other hormonal therapies that could be preventive, including testosterone, growth hormone-releasing hormone and DHEA (dehydroepiandrosterone).

Many studies have also investigated whether vitamins and dietary supplements can protect against cognitive decline and Alzheimer’s disease. Epidemiological and laboratory studies have suggested that antioxidants from food and supplements can lower the risk of Alzheimer’s disease by preventing oxidative damage from free radicals. Vitamin E, vitamin C, B vitamins, and coenzyme Q10 have been tested as treatments to slow down or prevent Alzheimer’s disease, but none have proved effective. Researchers are also investigating the effect of resveratrol—a compound found in red grapes and red wine.

Research has also revealed that healthy habits can have an important influence on the risk for Alzheimer’s disease and cognitive decline. Studies show that exercise can stimulate the brain and help to make new neuronal connections within the brain that are vital to healthy cognition. Daily aerobic exercise, for instance, can enhance recall and executive function. Research has also found that a diet rich in vegetables is associated with a reduced risk for cognitive decline, and a Mediterranean diet significantly lowers the risk for mild cognitive impairment and Alzheimer’s disease.

Keeping your mind active throughout life may also reduce the risk of Alzheimer’s disease. Large observational and epidemiological studies have associated cognitive health with the maintenance of social relationships at work, volunteering or by living with someone. Mentally stimulating activities such as reading books and magazines, playing game and going to lectures may also keep the mind sharp. Recent large studies have found that people who spend a lot of time in intellectually stimulating activities are significantly less likely to be diagnosed with Alzheimer’s disease.

For healthy people, formal cognitive training sessions also seems to have benefits for the brain. Studies on memory, reasoning, and processing speed training—all aimed at improving mental skills—show that this training can improve cognitive skills for up to 10 years. Other studies are now investigating whether the combination of exercise and cognitive training can delay or prevent age-related cognitive problems.

  1. National Institute on Aging. Alzheimer’s Disease: Unraveling the mystery. nia.nih.gov/
  2. National Institute on Aging. Alzheimer’s Disease Progress Report: Intensifying the Research Effort. nia.nih.gov
  3. Preventing Alzheimer’s Disease: What Do We Know? nia.nih.gov
  4. Alzheimer’s Association. Historic Alzheimer’s funding increase signed into law, answering Alzheimer’s Association call for action. alz.org

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Yoga and Osteoporosis

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yoga-876744_640By Barbara Boughton

Yoga practitioners have long touted the health advantages of their practice, including increased flexibility, improved balance and posture, and stress reduction.  Some research studies support these claims although the scientific evidence is far from conclusive.  Now, a new study highlights another possible benefit of yoga:  It may improve bone health — even for those with osteoporosis.

Loren M. Fishman, M.D., a physiatrist at Columbia University and a specialist in rehabilitative medicine, has studied the health benefits of yoga for years.  In 2009, Dr. Fishman and colleagues published a pilot study which showed that 11 subjects who practiced yoga regularly over two years showed significant improvements in bone mineral density (BMD) of the spine and hip when compared to seven controls who did no yoga.  To study the bone benefits of yoga in a larger study, Dr. Fishman invested his own money and solicited participants via the Internet to perform, over 10 years, 12 assigned yoga poses each day or every other day.

The results?  Ten years after beginning the yoga program, 227 of the moderately to fully adherent participants showed significant increases in BMD of the spine and femur, but not significant improvements in BMD of the hip, according to the study, published in the journal Topics in Geriatric Rehabilitation in November 2015.  The study’s results are striking because most participants were elderly, with a mean age of 68.  Moreover, 83% had osteoporosis or osteopenia at baseline.

From a DVD, the participants in the study learned the yoga poses.  The participants were instructed to hold each pose for 30 seconds.  Once the participants learned all the poses, the yoga regimen took just 12 minutes to complete.  During the study, the participants used an online program to record how many poses they did and how often.  The researchers collected data on the participants’ BMD.  The researchers also took X-rays of the spine and hips and took blood and urine chemistry at baseline. Ten years later, the moderately or fully adherent participants underwent repeat measurements of BMD and many also had repeat X-rays.

For the yoga regimen, the researchers selected poses that pitted one group of muscles against another and would be most likely to affect BMD of the femur, hip, and spine.  They also chose poses that would be safe for elderly patients with osteoporosis. Thus, the poses required, with a straight back, leg lifts, lunges, and/or twists.  The poses did not require bending the back.  At the conclusion of the study, the researchers wrote, there were no reported X-ray-detected fractures or serious injuries of any type that stemmed from the practice of yoga.

Yoga has distinct benefits over other treatments for osteoporosis because it is low cost and the “side effects of yoga include better posture, improved balance, enhanced coordination, greater range of motion, higher strength, reduced levels of anxiety and better gait,” the researchers wrote in their paper.  By contrast, elderly women treated with osteoporosis medications frequently suffer gastrointestinal side effects, and these side effects are often barriers to treatment compliance.

In fact, a recent study published in Clinical Interventions in Aging (2015) showed that, among 126,188 elderly female Medicare patients, only 28% had initiated and continued treatment one year after being diagnosed with osteoporosis. Gastrointestinal events affected a significant number of patients, including 69% of those patients that were non-adherent.

Still, the authors of the new study on yoga and bone health caution that their research has important limitations.  Many of the study’s participants had weakened bones at the start and were already performing yoga.  The participants’ behavior may have influenced the results.  Also, the study did not assess BMD in the thoracic spine, the forearm, or ribs — places where many osteoporotic fractures occur.  Most importantly, the design of the study — including the use of the Internet as a recruitment tool and the lack of a control group — may have selected participants likely to benefit from yoga and may have limited the conclusions clinicians can draw from the results.

While yoga may have health benefits for patients — and may even improve bone health — clinicians should also consider the potential for injury among elderly participants, especially those with osteoporosis.  Many orthopedic surgeons report that women who do yoga can suffer agonizing pain and serious wear and tear on the hip that can progress to arthritis, according to an article — by writer and book author William Broad — published as an editorial in The New York Times in 2013.

Among orthopedic surgeons, yoga poses are well known for causing hip injuries. The reason for the injuries — especially among women — is that the extreme leg motions of yoga can cause hip bones to strike one another repeatedly, according to the editorial in The Times.

There is much that is still unknown about the true benefits and risks of yoga. Studies on yoga have documented hip damage from the practice, for instance, but research also shows that yoga can help patients cope with the pain of osteoarthritis and fight joint inflammation.

To obtain health benefits from yoga and avoid injury, it is crucial to practice gentler forms of this exercise and to moderate poses if they are painful. “Better to do yoga in moderation and listen carefully to your body.  That temple, after all, is your best teacher,” wrote author William Broad in the Times’ editorial.

References:

  1. Lu YH, Rosner B, Chang G, et al. Twelve-minute daily yoga regimen reverses osteoporotic bone loss. Topics in Geriatric Rehabilitation. November 2015.
  2. Fishman L Yoga for osteoporosis: A pilot study. Topics in Geriatric Rehabilitation. 2009; 25 (3): 244-50.
  3. Siris ES, Yu J, Bognar K, et al. Undertreatment of osteoporosis and the role of gastrointestinal events among elderly osteoporotic women with Medicare Part D drug coverage. Clinical Interventions in Aging. November 5,
  4. Brody JE. Twelve minutes of yoga for bone health. The New York Times. December 21, 2015.
  5. Broad WJ. Women’s flexibility is a liability (in yoga). Editorial, The New York Times. November 2, 2013.

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