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August 2004

Old but Not Aged
Alzheimer's Updates
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

Old but Not Aged

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 Updates

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.

Alzheimer’s and Healthy Living

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.

Diet, Fats, and Inflammation

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.

Ask Dr. J: Vitamin B3 Safety

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.

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Alzheimer’s Disease:

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.

Diet, Fats, and Inflammation:

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.

Vitamin B3:

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.

In The Health News

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.

Diet and Disease

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.

Recipe of the Month: Mexican Bean-Stuffed Tortilla

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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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.