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February 2004

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

Fooled by Fad Diets

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.

Prevent and Treat Dementias

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.

Lifestyle and Brain Function

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.)

Supplements for Dementia

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.

Ask Dr. J: Crohn's Disease

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).

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References

Fooled by Fad Diets:

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.

Preventing and Treating Dementias:

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.

Crohn’s Disease:

Persson PG, et al., Diet and inflammatory bowel disease: a case-control study. Epidemiology. 1992 Jan;3(1):47-52.

In The Health News

  • 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?

Diet and Disease

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.)

Recipe of the Month: Hearty Three Bean Soup

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.

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CONSULTATIONS:

From September to June, I see patients in New Smyrna Beach, Florida.
Call 386-409-7747, or send an email to to make arrangements.

In summer, I have a variable schedule, and I see patients in offices at the
Rothfeld Center for Integrative Medicine in Waltham, Massachusetts. For appointments, send an email to make arrangements, or call: 386-409-7747.

I primarily do phone consultations, as well as email and instant messaging consults.


Information herein is not medical advice or direction. All material in this newsletter is provided for information only. Its contents should not be used to provide medical advice on individual problems. Consult a health care professional for medical or health advice.

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