Old but Not Aged
Alzheimer's and Healthy Living
Diet, Fats, and Inflammation
Ask Dr. J: Vitamin B3 Safety
In the Health News
Diet and Disease
Recipe of the Month: Grilled Salmon and Veggies
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
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
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
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
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
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
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
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
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
--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.
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Pedersen NL, et al., How heritable is Alzheimer’s
disease late in life? Findings from Swedish twins. Ann Neurol.
Plassman BL, The 9th International Conference
on Alzheimer’s Disease and Related Disorders (ICAD).
Wolozin B, The 9th International Conference
on Alzheimer’s Disease and Related Disorders (ICAD).
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
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.
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