Saturday, September 29, 2018

Saving your brain


Over 5 million people in the United States currently suffer with dementia.  And if you are fortunate enough to live to age 85, it’s estimated your chances of exhibiting signs of dementia are at least one in four, and perhaps as high as one in two (50%).


These are alarming statistics but there is hope.  In a moment we’ll look at options that are estimated to cut your risk by a third.


Dementia refers to a set of symptoms (impaired decision making, misuse of language, and memory lapses) which can be found in a number of diseases.
Alzheimer’s is the most common cause, responsible for 60 to 70% of all  cases of dementia.


“Vascular dementia”, the result of diminished blood flow to the brain, comes in second with another third of the cases.


Prevention is the key to beating dementia as once symptoms develop, indicating the presence of ongoing damage, they are generally irreversible.
As you will see, options include many of the lifestyle changes that are common to other vascular or blood flow related diseases such as heart attacks and strokes. But to be effective they will need to be adopted in midlife.  


Diabetes and Blood Pressure Management


Diabetes, high blood pressure and obesity all contribute to premature aging of blood vessels. Whether it is preventing heart attacks, stroke (the major vessels to the brain), or vascular dementia (the small blood vessels), control of blood pressure and blood sugar levels are of unquestionable benefit.


Diet


Diet can have a powerful effect. And it is about both the negative effects of foods you should avoid as well as the positives of those you should add to your diet.


One study showed that those following a Mediterranean diet had less brain atrophy — an effect similar to 5 years of aging — than those who did not. And another that those who consumed two servings of green leafy vegetables a day had a rate of cognitive decline equivalent to someone 11 years younger.


And the foods to be avoided?  Red meat, butter, margarine, cheese, sweets, fried and processed foods, and empty sugar calories such as sodas.


Although it is not traditionally considered a “food”, alcohol in large amounts has been firmly linked to dementia, and even small amounts on a regular basis produce brain damage on neuroimaging studies.  This finding implies there is no “safe” level of intake for alcohol.


Social Engagement/Marriage


Having strong social networks as well as marriage are dementia protective.
Being a loner is associated with a number of poor health outcomes including cancer survival.  Why? Those in a relationship or with strong social networks tend to live healthier lifestyles.


Or perhaps being able to share worries moderates life’s stresses which are know to correlate with an increased risk of subsequent dementia.


Exercise


Last but not least is exercise. Of all the prevention options, this is the most powerful.


A group of 191 Swedish women, 38-60 years of age in 1968, were given an ergometer cycling test. When their mental status was valuated in 2010 (fourty years later), it was found that the women with high physical fitness at middle age were nearly 90% less likely to have developed dementia compared with the women who were only moderately fit.


Medications


Are there any medications of preventive value?


Vitamin E and Selenium, commonly suggested anti oxidants, have no protective benefit.


There is limited information on metformin, an insulin “sensitizer” and effective anti-aging medication in a mouse model.  Although it does diminish the incidence of dementia in diabetics (presumably via treatment of the diabetes itself) there is no solid evidence that it has a protective benefit for those with normal blood sugar metabolism.


But there is a glimmer of hope on the medication horizon. Smoking dope. The long term administration of THC, the main psychoactive ingredient in marijuana, ameliorates age related learning and memory deficits in elderly mice even though, paradoxically,  it impairs learning and memory in young mice.


How can that be? One of our many neurochemical pathways is the cannabinoid system.  As we age, this pathway, along with the others, becomes less active. In old animals, THC treatment restores the failing cannabinoid system activity, whereas it overactivated the normally functioning cannabinoid system of young animals.


So we once again see a theme that is common to many of the diseases of aging - an active lifestyle paired with a vegetarian leaning diet. But for the brain, we will add the importance of avoiding social isolation. Three lifestyle changes that you can add in small amounts to daily routines and will add years of benefit down the road.

 References:

https://www.amjmed.com/article/S0002-9343(18)30643-0/fulltext

 https://tandfonline.com/doi/abs/10.1080/1028415X.2017.1324357

 http://www.aginganddisease.org/EN/10.14336/AD.2017.0501

 https://www.ncbi.nlm.nih.gov/pubmed/26491085

 https://www.frontiersin.org/articles/10.3389/fnagi.2017.00183/full

https://www.nature.com/articles/nm.4311.epdf

 https://www.ncb i.nlm.nih.gov/pubmed/29263222

 https://www.bmj.com/content/361/bmj.k1675

 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5894933/

 https://jnnp.bmj.com/content/early/2017/10/30/jnnp-2017-316274

https://www.thelancet.com/commissions/dementia2017

 http://www.drmirkin.com/fitness/exercise-preserves-brain-function.html 

 http://www.health.harvard.edu/press_releases/regular-exercise-releases-brain-chemicals-key-for-memory-concentration-and-mental-sharpness

http://www.health.harvard.edu/press_releases/regular-exercise-releases-brain-chemicals-key-for-memory-concentration-and-mental-sharpness

 https://www.nytimes.com/2018/03/28/well/mind/fitness-in-midlife-may-help-fend-off-dementia.html

 https://www.nytimes.com/2017/10/04/well/move/for-your-brains-sake-keep-moving.html

https://www.bmj.com/content/361/bmj.k1675 Exercise no help once you have it.


http://www.drmirkin.com/morehealth/risk-for-dementia-goes-down-with-steps-to-prevent-heart-attacks.html

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Thursday, September 6, 2018

Use it or lose it….perhaps forever!


Regular exercise is essential to staying healthy. It maintains our muscle tone, keeps the arteries healthy (preventing strokes  and heart attacks), and minimizes the memory loss of aging. One of its less obvious, but no less important, effects is on insulin metabolism, reducing the risk of developing type 2 diabetes.

 Most of us assume we can take a break (often for vacation) from our regular exercise routine with no downside risk beyond a little extra effort to get back up to speed on our return to the gym.  But new work suggests the deconditioning effects of that break may not be completely reversible, especially as we get older.

 One study of middle aged adults (average age 35) confirmed this decrease in the body’s insulin sensitivity after just 2 weeks of slacking off on their daily exercise. This younger group returned to their baseline a few weeks after returning to their normal routine.

 A second study evaluated an older, pre diabetic population (average age 69). It again documented a decrease in insulin sensitivity that correlated with the reduction in activity, but then, surprisingly, went on to document an incomplete recovery.

 These two studies give new credence to the adage "use it or lose it" in that the loss of exercise related conditioning may not be completely reversible.

 But you do have several alternatives. Although you may not be able to stick with your full exercise routine, you should be able to maintain your conditioning with a more limited workout regimen.

 First, you can cut back on the level of exertion. It has documented that participants can actually improve strength and endurance exerting at only 55% to 85% of their personal maximum, a level that is just uncomfortable on a “perceived exertion” scale.

 But more importantly you can cut back on the duration of your sessions.

For aerobic conditioning (heart and lungs) you may have to push your level of discomfort as the trade off for time spent by using HIIT (high intensity interval training).  This will prevent deconditioning, and can in some instances actually improve aerobic fitness 10 times more quickly than moderate endurance training.

HIIT requires an all out effort for 30 to 60 seconds followed by a minute of recovery. Repeat five sets - three times a week. Although it may sound like more than you might want to take on, numerous studies have shown HIIT to be more acceptable to participants than slower (and longer) aerobic routines. And best of all,  you can maintain your aerobic fitness with just 3 ten minute sessions a week.

 Then we have muscle tone/strength.

 Here the “aha” studies have shown that you can decrease the weights you are using, pushing just 70% of a personal one-time maximum for 30 repetitions, the point at which your muscles begin to fatigue).

 And more recently “slow lifting” with each rep performed in a slow and more deliberate way rather provides equal benefit to fast repetitions. So a slow set of 30 repetitions will get you almost the same benefit as the dreaded “set of 3” that make up the traditional gym routine.

 So there you have it. Take that vacation. Commit to 3 HIIT sessions a week (you can do them anywhere). And if you have access to a weight machine, add in several sets using modest weight to the point of muscle fatigue.

Then you will be ready to settle right back into your regular gym routine when you get home.



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