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May 2008

Vitamin E reduces mortality
Medications hasten mental decline
Mediterranean diet for the brain
DASH diet for adolescents
Soy protein lowers diabetics’ risks
Exercise “reduces” obesity risks
Vitamin D may help blood vessels

Vitamin E reduces mortality

A recent study of 847 patients with either early Alzheimer’s disease or other forms of dementia and an average age at the start of the study of 73 years showed benefits from taking 2000 IU of vitamin E. Patients were followed for an average of 5 years, and up to 14 years overall. They were given the high dose of vitamin E with or without a cholinesterase inhibitor, the drug alone, or no treatment.

Those patients who took vitamin E with or without medication had a mortality rate that was 26 percent lower than baseline. While these patients lived 26 percent longer, those who took only medication had a trend to a 9 percent lower mortality, but this was not statistically significant.

This report contradicts the inaccurate conclusions of a few reports that vitamin E might in some way increase mortality. The findings were presented at a meeting of the American Academy of Neurology (Pavlik V, et al, Vitamin E Use Is Associated with Improved Survival in an AD Cohort [P03.076] Poster Session, Meeting of the American Academy of Neurology, 2008 April

Medications hasten mental decline

At the same meeting, a report showed that medications can hasten mental decline in elderly patients. Anti-cholinergic medications (also known as anti-muscarinic drugs) are prescribed for stomach ulcers, motion sickness, and urinary incontinence or overactive bladder, but they apparently have unexpected consequences. Among 870 subjects who averaged 75 years old, cognitive function declined 1.5 times as fast in those who took these drugs compared to those who did not.

Of these 870 subjects, 679 of them were on at least one of these medications, which is an interesting figure in itself. They were followed for an average of 9 years. Previous studies by some of the same researchers showed this side effect in 2005. (Kay GG, et al., Antimuscarinic drugs for overactive bladder and their potential effects on cognitive function in older patients. J Am Geriatr Soc. 2005 Dec;53(12): 2195-201.)

Mediterranean diet for the brain

A Mediterranean diet (MD) that is high in fresh vegetables, fruits, legumes, grains, fish, and olive oil is associated with reduced rates of heart disease and other conditions (although not as low a rate as is seen with the Japanese or Chinese native diets). A new report shows that MD is associated with lower rates of mild cognitive impairment (MCI) and a lower incidence of conversion from such impairment to Alzheimer’s disease (AD).

This study included 1639 subjects without any cognitive impairment at the start of the study, 504 subjects with mild cognitive impairment, and 214 with Alzheimer’s disease. They were followed for over 4 years. Subjects in the middle and those with the highest scores for adherence to MD had a 25 percent lower risk of developing MCI than those with the lowest adherence scores.

In addition, those with the middle and highest scores for adherence to MD had about half the risk of developing Alzheimer’s disease than those with the lowest scores. (Scarmeas N, et al., Mediterranean Diet (MeDi) and Mild Cognitive Impairment (MCI). Meeting of the American Academy of Neurology, S21, 2008 April 16.)

DASH diet for adolescents

The DASH diet (Dietary Approaches to Stop Hypertension) is high in fruits, vegetables, fiber, and low-fat dairy products, and low in saturated fat and salt. New research shows that this diet also works to lower hypertension in adolescents.

Over a three-month period, adolescents from 11 to 18 years old who were counseled on increasing fruits and vegetables in the diet actually doubled their intake, and correspondingly increased their consumption of potassium and magnesium. They also decreased high fat and salt foods and their total fat intake. The study included 57 boys and girls with elevated blood pressure.

Pressures were significantly reduced at the post-intervention evaluation, but three months later, the improvements were declining, suggesting that the counseling needs to be ongoing to maintain good results. (Couch SC, The efficacy of a clinic-based behavioral nutrition intervention emphasizing a DASH-type diet for adolescents with elevated blood pressure. J Pediatr. 2008 Apr;152(4):494-501.)

With peer pressure, advertising, time constraints, and early habits, it is difficult for adolescents to maintain healthy lifestyles after such a short intervention. It is critical to have ongoing education and both peer and family support for healthy lifestyles to become ingrained habits.

Soy protein lowers diabetics’ risks

Diabetics are prone to develop chronic degenerative diseases of the heart, blood vessels, and kidneys, although with better control of blood sugar these risks are somewhat reduced. It appears that eating soy protein regularly helps diabetics to reduce all of these risks.

In a four-year study of 41 patients with type II diabetes, 20 of them were on a diet that contained 0.8 grams of protein per kilogram of body weight (about 40 grams per 110 pounds) including 35 percent animal protein, 35 percent soy protein, and 30 percent vegetable protein.

The remaining 21 subjects ate the same amount of protein, but 70 percent of it was animal protein and 30 percent from vegetable sources. The group eating the soy protein had significantly lower blood sugars, lower cholesterol, and lower serum levels of C-reactive protein (CRP, an inflammatory marker that is a risk factor for heart disease). The soy protein group also had better kidney function, such as lower urine protein levels. (Azadbakht L, et al., Soy protein intake, cardiorenal indices, and C-reactive protein in type 2 diabetes with nephropathy: a longitudinal randomized clinical trial. Diabetes Care. 2008 Apr;31(4):648-54.)

In addition, LDL cholesterol (the riskier one) was reduced by soy protein, as was the triglyceride level. Unfortunately, the soy protein was in the form of “texturized vegetable protein”, which is highly processed and likely not as healthy as foods such as tofu, soy milk, tempeh, and miso, all of which are minimally processed. It would be interesting to see a comparison in people from cultures where soy protein in a less processed form is a regular part of the diet.

Exercise “reduces” obesity risks

Exercise can reduce, but not eliminate, the increased risk of heart disease associated with obesity. In the Women’s Health Study of 38,987 subjects, the subjects were free of heart disease, diabetes, and cancer at the start and were followed for an average of 11 years. They were placed in categories based on body mass index (BMI) of normal (BMI under 25), overweight (BMI 25-30), or obese (BMI over 30). They were also categorized according to levels of physical activity – active subjects were those who expended more than 1000 calories per week recreationally.

Subjects with the highest risk of cardiovascular disease were those who were obese and did the least exercise. They had a 250 percent increase in risk. Overweight (but not obese) subjects who exercised had a 54 percent higher risk of heart disease, than those who were lean and also exercised. Those subjects who were lean but did not exercise had a slight 8 percent increased heart risk.

Overweight people who did not exercise had the same risk increase (87 percent) as those who were obese but active. It is clear from this study that exercise is an important part of any heart disease prevention program, but it is not as important as maintaining normal weight with a healthier diet. (Weinstein AR, et al., The joint effects of physical activity and body mass index on coronary heart disease risk in women. Arch Intern Med. 2008 Apr 28;168(8):884-90.)

Vitamin D may help blood vessels

Vitamin D has been shown to have many effects beyond the benefits to bone development and maintenance. Studies have shown that it may also have benefits for cardiovascular disease (a study in January showed that low vitamin D levels were associated with increased heart attacks, heart failure, and strokes).

A new article shows an association between low vitamin D levels and peripheral vascular disease (PVD; blockage of circulation to the legs due to hardening of the arteries.) In a study of 4839 participants in the National Health and Nutrition Examination Survey (NHANES), those with the lowest serum levels of 25-OH vitamin D (the bottom 25 percent) had nearly twice the risk of PVD as those with the highest levels (the top 25 percent). This was measured by a common test comparing the blood pressure in the arm with that in the ankle. (Melamed ML, et al., Serum 25-Hydroxyvitamin D Levels and the Prevalence of Peripheral Arterial Disease. Results from NHANES 2001 to 2004. Arterioscler Thromb Vasc Biol. 2008 Apr 16 [Epub ahead of print])

Subjects in the middle range of vitamin D levels had a risk in the middle of the other two groups. While this study does not show a cause and effect relationship, nor that taking vitamin D will cure or prevent PVD, it is one more piece of evidence that vitamin D is important for the health of blood vessels. Considering the prevalence of low vitamin D levels, especially in elderly people (even if they are exposed to the sun) it suggests that supplements would be worthwhile.

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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.

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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.