Category Archives: Dementia

One More Reason to Avoid Proton Pump Inhibitors: Dementia

I have nothing against Prilosec in particular. It can be very helpful.

There are reasons our stomachs produce acid. One is that the acid helps kill pathogens in our food before they make us sick. Another is to start the digestion of proteins we eat. You can imagine that drastically reducing stomach acid production has some potential adverse effects.

We have two major classes of drugs that reduce acid production by the stomach. The first was H2 blockers, the granddaddy being Tagamet (cimetidine). Tagamet was the first H2 blocker on the market in the U.S., probably 25–30 years ago. Several H2 blockers are are available without a prescription. The second and later class of acid-reducing drugs are the PPIs: proton pump inhibitors. These are more potent than H2 blockers. Because of H2 blockers and PPIs, and the discovery that H. pylori causes many ulcers, we have many fewer patients requiring surgery for upper GI ulcers. Surgery like Billroth’s and vagotomy & pyloroplasty. Once the ulcer heals, most folks don’t need to take a PPI for the rest of their lives.

Bix at Fanatic Cook turned me on to the possibility that chronic use of  PPIs might cause cognitive decline, up to and including dementia. In the U.S., PPIs are available over-the-counter and many physicians prescribe and recommend them to patients in order to reduce stomach acid. The most common reason for chronic usage must be gastroesophageal reflux disease (aka GERD), which is severe or frequently recurrent heartburn. Common PPI names are Protonix, Nexium, Prilosec, omeprazole, and pantoprazole.

A German population study a few years ago linked PPI usage with higher risk of dementia.

A total of 73,679 participants 75 years of age or older and free of dementia at baseline were analyzed. The patients receiving regular PPI medication (n = 2950; mean [SD] age, 83.8 [5.4] years; 77.9% female) had a significantly increased risk of incident dementia compared with the patients not receiving PPI medication (n = 70,729; mean [SD] age, 83.0 [5.6] years; 73.6% female) (hazard ratio, 1.44 [95% CI, 1.36-1.52]; P < .001).

The avoidance of PPI medication may prevent the development of dementia. This finding is supported by recent pharmacoepidemiological analyses on primary data and is in line with mouse models in which the use of PPIs increased the levels of β-amyloid in the brains of mice. Randomized, prospective clinical trials are needed to examine this connection in more detail.

Source: Association of Proton Pump Inhibitors With Risk of Dementia: A Pharmacoepidemiological Claims Data Analysis – PubMed

I don’t know about Germany, but there’s evidence that the incidence of dementia has been decreasing lately in the U.S. I’m guessing that the use of PPIs has been increasing over the last couple decades. So this doesn’t fit with the PPI-dementia theory.

Check out Bix’s article to read that:

  • PPIs interfere with production of acetylcholine, a major chemical than nerve cells use to communicate with each other
  • Healthy young folks who took a PPI for 10 days performed worse on tests of memory

If you have GERD, a low-carb diet may well control it, allowing you to avoid the side effects of PPIs, not to mention the cost.

Oh, darn. I may not be getting my check from Big Pharma this month.

Steve Parker, M.D.

PS: Buy one of my books so I don’t have to depend on Big Pharma.

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Mediterranean Diet Linked to Improved Verbal Memory in Type 2 Diabetes

 

Steve Parker MD, low-carb diet, diabetic diet

Olives, olive oil, and vinegar: classic Mediterranean foods

Click for my description of the traditional Mediterranean diet.

From a recent study done in Germany:

These data suggest that closer adherence to MedD (the Mediterranean diet) was associated with better performance in verbal memory in patients with type 2 diabetes with known diabetes duration ≥5 years, but not in patients with recently diagnosed type 2 diabetes or in patients with type 1 diabetes or metabolically healthy individuals.

The MedD has been already reported to exert beneficial effects on cardiovascular disease and additionally on cognitive performance mainly in healthy elderly individuals or individuals with increased cardiovascular risk. The present results show an association between MedD and verbal memory in individuals with diabetes. Although the underlying mechanisms are currently unknown, one may speculate that the high content of antioxidants in MedD may contribute to better cognitive performance by reducing the production of reactive oxygen species and attenuating inflammatory processes, both of which have been linked to cognitive decline. Furthermore, positive effects might be mediated by n-3 fatty acids (FA). Higher dietary n-3 FA intake or circulating blood n-3 FA levels have been associated with better global or single cognitive function which was mainly explained by their anti-inflammatory, antioxidative and antithrombotic properties. However, the influence of n-3 FA is controversial according to the literature, as not all studies observed beneficial effects, possibly due to different study designs, methods and varying quality of studies.

Source: Associations between cognitive performance and Mediterranean dietary pattern in patients with type 1 or type 2 diabetes mellitus | Nutrition & Diabetes

Steve Parker, M.D.

low-carb mediterranean diet

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Low-Carb Diet Could Improve Brain Health

MRI of brain

From Stony Brook University News:

A diet low in carbohydrates could stave off, or even reverse, the effects of aging on the brain, Stony Brook-led research finds.

A study using neuroimaging led by Stony Brook University professor and lead author Lilianne R. Mujica-Parodi, PhD, and published in PNAS, reveals that neurobiological changes associated with aging can be seen at a much younger age than would be expected, in the late 40s. But the study also suggests that this process may be prevented or reversed based on dietary changes that involve minimizing the consumption of simple carbohydrates.

Even in younger adults, under age 50, dietary ketosis (whether achieved after one week of dietary change or 30 minutes after drinking ketones) increased overall brain activity and stabilized functional networks.

Source: Low-Carb Diet Could Boost Brain Health, Study Finds | | SBU News

Steve Parker, M.D.

PS: You know what else helps preserve brain health? The Mediterranean diet.

low-carb mediterranean diet

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Prevent Dementia With This Healthy Lifestyle

Yes, some cases of dementia are preventable. If you have a genetic predisposition to develop dementia, the deck is stacked against you. But it’s not hopeless. A healthy lifestyle will help you, too.

The research at hand was done in the UK and involved over 500,000 older adults of European ancestry, free of dementia and cognitive impairment at baseline.

So what are the healthy lifestyle characteristics linked to lower risk of dementia, whether you have genetic risk or not?

  • Physical activity
  • Not smoking
  • Healthy diet
  • Judicious alcohol consumption

Lifestyle details from the research report:

A healthy lifestyle score was constructed based on 4 well-established dementia risk factors (smoking status, physical activity, diet, and alcohol consumption) assessed at baseline using a touchscreen questionnaire. Participants scored 1 point for each of 4 healthy behaviors defined on the basis of national recommendations (full details in eTable 1 in Supplement 1). Smoking status was categorized as current or no current smoking. Regular physical activity was defined as meeting the American Heart Association recommendations of at least 150 minutes of moderate activity per week or 75 minutes of vigorous activity per week (or an equivalent combination) or engaging in moderate physical activity at least 5 days a week or vigorous activity once a week. Healthy diet was based on consumption of at least 4 of 7 commonly eaten food groups following recommendations on dietary priorities for cardiometabolic health, which are linked to better late-life cognition and reduced dementia risk. Previous studies of alcohol consumption and dementia risk support a U-shaped relationship, with moderate consumption associated with lower risk. Therefore, moderate consumption was defined as 0 to 14 g/d for women and 0 to 28 g/d for men, with the maximum limit reflecting US dietary guidelines.

Source: Association of Lifestyle and Genetic Risk With Incidence of Dementia | Dementia and Cognitive Impairment | JAMA | JAMA Network

What do they consider a healthy dementia-preventing diet? At least four of the following food groups and consumption levels:

  • Fruits: 3 or more servings a day
  • Veggies: 3 or more servings a day
  • Fish: 2 or more servings a week
  • Processed meats: no more than 1 serving a week
  • Unprocessed red meats: no more than 1.5 servings a week
  • Whole grains: 3 or more servings a day
  • Refined grains: no more than 1.5 servings a day

Regarding alcohol, the guideline is no more than one drink a day for women, and no more than two a day for men. Do a web search for standard drink sizes if needed. “One drink” is 14 grams of pure alcohol.

Steve Parker, M.D.

PS: You do know that the Mediterranean diet is linked to lower risk of dementia, don’t you?

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Dr David Ludwig Calls for More Research on Ketogenic Diets

Sous vide chicken and sautéed sugar snap peas. This meal is part of a ketogenic diet.

From The Journal of Nutrition:

Recently, ketogenic diets have received substantial attention from the general public and nutrition research community. These very-low-carbohydrate diets, with fat comprising >70% of calories, have been dismissed as fads. However, they have a long history in clinical medicine and human evolution. Ketogenic diets appear to be more effective than low-fat diets for treatment of obesity and diabetes. In addition to the reductions in blood glucose and insulin achievable through carbohydrate restriction, chronic ketosis might confer unique metabolic benefits of relevance to cancer, neurodegenerative conditions, and other diseases associated with insulin resistance. Based on available evidence, a well-formulated ketogenic diet does not appear to have major safety concerns for the general public and can be considered a first-line approach for obesity and diabetes. High-quality clinical trials of ketogenic diets will be needed to assess important questions about their long-term effects and full potential in clinical medicine.

Source: Ketogenic Diet: Evidence for Optimism but High-Quality Research Needed | The Journal of Nutrition | Oxford Academic

Steve Parker, M.D.

PS: Click the pic below or here for a ketogenic diet.

low-carb mediterranean diet

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Judicious Wine Consumption May Prevent Dementia

“Is the room spinning, or is it just me?”

The inverse relationship between moderate wine drinking and incident dementia was explained neither by known predictors of dementia nor by medical, psychological or socio-familial factors. Considering also the well documented negative associations between moderate wine consumption and cardiovascular morbidity and mortality in this age group, it seems that there is no medical rationale to advise people over 65 to quit drinking wine moderately, as this habit carries no specific risk and may even be of some benefit for their health. Advising all elderly people to drink wine regularly for prevention of dementia would be however premature at this stage.

Source: Wine consumption and dementia in the elderly: a prospective community study in the Bordeaux area. – PubMed – NCBI

But remember, excessive alcohol consumption is linked to cognitive decline.

Steve Parker, M.D.

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords.com.

 

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High-Intensity Interval Training May Prevent Dementia

Steve Parker MD

A slow leisurely pace won’t cut it

Dementia is a devastating and expensive development for an individual and his family. Most dementias are progressive and incurable. If it can be prevented, it should be. Exercise is one preventative. But how much and what kind of exercise?

Nine percent of U.S. adults over 65 have dementia. That’s 3.650,000 folks. The initial clue to incipient dementia is usually memory impairment.

From The Globe and Mail:

In 2017, a team led by the lab’s director, Jennifer Heisz, published a five-year study of more than 1,600 adults older than 65 that concluded that genetics and exercise habits contribute roughly equally to the risk of eventually developing dementia. Only one of those two factors is under your control, so researchers around the world have been striving to pin down exactly what sort of workout routine will best nourish your neurons.

Heisz’s latest study, published last month in the journal Applied Physiology, Nutrition, and Metabolism, offers a tentative answer to this much-debated question. Older adults who sweated through 12 weeks of high-intensity interval training improved their performance on a memory test by 30 per cent compared with those who did a more moderate exercise routine.

This was a small study, only about 20 sedentary participants (all over 60 years old) subjected to one of three protocols for twelve weeks, exercising thrice weekly:

  1. Four-minute bouts of vigorous treadmill walking at 90-95% of maximum heart rate, repeated four times, with three minutes easy walking between the high-intensity spells intervals (HIIT)
  2. Walking at 70-75% of max heart rate for 47 minutes (burning the same number of calories as group #1
  3. Thirty minutes of relaxed stretching

Alex Hutchinson’s full article is well worth a couple minutes of your time if you want to avoid dementia.

Source: New study shows the right workout routine can help fight dementia – The Globe and Mail

Most experts agree that diabetes is a risk factor for dementia, and the Mediterranean diet helps prevent it.

Steve Parker, M.D.

low-carb mediterranean diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords.com.

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Can Diet Alter Your Gut Bacteria and Thereby Lower Your Risk of Dementia?

The short answer? We don’t know.

Low-carb salad

The gut bacteria (aka microbiome) seem to be able to decrease or increase inflammation that could cause or exacerbate Alzheimer’s dementia. The  microbiome’s effect on inflammation depends on the species of bacteria present, and the amount of those bacteria. At least one study found that Alzheimer’s patients have a greater abundance of the pro-inflammatory species and less of the anti-inflammatory species, compared to other folks.

Researchers with Wake Forest School of Medicine tried to find answers to the questions in the title of this post. (Click for full text.) They studied 17 experimental subjects, average age 64, who had mild cognitive impairment (11) or “cogni/subjective memory complaints” (6). God bless them for submitting to three spinal taps apiece. The experimental diets were 1) Mediterranean-Ketogenic (under 20 g carb/day), or 2) Low-fat American Heart Association diet (under 40 g fat/day). Participants were on each diet for six weeks.

The investigators didn’t find anything useful for those of us trying today to avoid Alzheimer’s or prevent the progression of mild cognitive impairment to dementia. Their bottom line is, “The data suggest that specific gut microbial signatures may depict [characterize] the mild cognitive impairment and that the modified Mediterranean-ketogenic diet can modulate the gut microbiome and metabolites in association with improved Alzheimer’s disease biomarkers in cerebrospinal fluid.”

So we won’t know for several more years, if ever, whether intentional modification of diet will “improve” our gut microbiomes, leading to lower risk of dementia.

What we have known for many year, however, is that the traditional Mediterranean diet is linked to lower risk of Alzhiemer’s dementia.

For more details, see Science Daily:

In a small pilot study, the researchers identified several distinct gut microbiome signatures — the chemicals produced by bacteria — in study participants with mild cognitive impairment (MCI) but not in their counterparts with normal cognition, and found that these bacterial signatures correlated with higher levels of markers of Alzheimer’s disease in the cerebrospinal fluid of the participants with MCI.

Through cross-group dietary intervention, the study also showed that a modified Mediterranean-ketogenic diet produced changes in the gut microbiome and its metabolites that correlated with reduced levels of Alzheimer’s markers in the members of both study groups.

Source: Diet’s effect on gut bacteria could play role in reducing Alzheimer’s risk — ScienceDaily

Steve Parker, M.D.

Click the pic to purchase the world’s first practical ketogenic Mediterranean diet at Amazon.com. E-book versions also available at Smashwords.com.

If you own this book, you already have a ketogenic Mediterranean diet.

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Mediterranean Diet and Good Blood Sugar Levels Improve Brain Function in Type 2 Diabetes

MRI scan of brain

From Diabetes Care:

CONCLUSIONS

Both adhering to a Mediterranean diet and effectively managing type 2 diabetes may support optimal cognitive function. Healthy diets, in general, can help improve memory function among adults without type 2 diabetes.

Source: The Mediterranean Diet and 2-Year Change in Cognitive Function by Status of Type 2 Diabetes and Glycemic Control | Diabetes Care

Steve Parker, M.D.

low-carb mediterranean diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords.com.

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Are Oral Bacteria the Cause of Alzheimer’s Dementia?

Several respected researchers think that Alzheimer’s dementia may primarily be an infectious disease, particularly related to gum bacteria.

From MedScape:

LOS ANGELES — As more disappointing results emerge from anti-amyloid drug trials in Alzheimer’s disease (AD), there is growing interest in novel treatment approaches for this condition.

One such approach is based on the hypothesis that Porphyromonas gingivalis (Pg), the bacteria involved in periodontal disease, may cause AD. The biopharmaceutical company Cortexyme Inc is testing this theory with an investigational agent COR388, which targets gingipains, the toxic proteases released by Pg.  Early results show the drug is well tolerated and promising in terms of biomarker findings. Organizers hope that a phase 2/3 trial of the treatment now under way will provide definitive efficacy results.

Source: Gum Disease Bacteria a Novel Treatment Target for Alzheimer’s?

Steve Parker, M.D.

PS: The Mediterranean diet had been shown to reduce the risk of dementia.

low-carb mediterranean diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords.com.

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