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January 30, 2012

Healthy Lifestyles for Chronic Illness: Heart, Diabetes, Stroke, Cancer and Possibly Alzheimer's Disease
Ernest H. Rosenbaum, MD

1. Increase intake of fish with polyunsaturated Omega-3 fats DHA (Docosahexaenoic acid) and EPA (eicosapentaenoic acid) to at least three times a week. DHA and EPA are high protecting oils that may also be brain protective. DHA is a common fat in nerve cells and is decreased in Alzheimer's disease. DHA does cross the blood-brain barrier and may help nourish nerve cells. In the Framingham Heart Study, those eating fish three times a week had half the amount of dementia than those eating less. Omega-3 fats help protect patients with high blood pressure, and low HDL cholesterol, and high triglycerides.
Thus, there is an association between increased DHA consumption and improved cognition, as well as heart disease. The goal is to eat fatty fish (salmon, herring) about five ounces a week versus thirty ounces of leaner fish (cod, haddock, or tuna). Fish oil or vegetarian Omega-3 (phytoplankton) is an option.

2. Reduce saturated and trans fats from your diet.
In the Chicago Health and Aging Project (CHAP), there was twice the risk of Alzheimer's in those eating the most saturated fats (25 gm per day) versus the least. Those eating 1.8 gm of trans fats doubled their risk. Increase in the saturated fat, palmitic acid, correlated with cognitive decline.
Statin drugs may help protect against Alzheimer's (the cholesterol-transport gene apoE e4).

3. Green vegetables
Iceberg and romaine lettuces, kale, and spinach may help reduce the cognitive decline. There is no correlation with fruits. Three servings per day correlated with a 40% slower rate of cognitive decline (CHAP study).
Studies at Tufts University showed blueberry extracts helped decrease amyloid-rich plaques in rats, who performed better in maze testing. No human data is available.

4. Vitamin E
There is thus far no data that 600 IU vitamin E affected cognition. Of note is that beta-carotene, C, E, and zinc helped reduce the risk of macular degeneration.
There is some data suggesting that vitamin E-rich foods may help reduce the cognitive decline of Alzheimer's disease (vegetable oils, nuts, seeds, green vegetables, and whole grains).
Of note is that gamma tocopherol is anti-inflammatory.

5. Reduce or control diabetic risk
The goal is to have a fasting blood sugar less than 100, as pre-diabetics have a blood sugar between 100 and 125. Diabetics have a fasting blood sugar greater than 125. Pre-diabetics may have a higher risk of cognitive decline - 64% higher versus 79% higher in diabetics. Diabetics with insulin resistance have a higher risk of heart disease and cognitive decline, "like being ten to fifteen years older" (Grodstein - Harvard School of Public Health). Diabetes promotes small vessel arterial sclerosis affecting heart, brain and the body. Higher insulin levels (type 2 diabetes) promote senile brain plaques with amyloid (insulin may reduce amyloid breakdown).

6. Weight control
Weight control, exercise, and a healthy prudent diet is recommended. In addition to diabetes, excessive weight can be related to increasing dementia in later life, as there is information that the fat cells release hormones causing inflammation that can damage the brain. In a study at Kaiser by Kristine Yaffe (10,000 patients), middle-aged, overweight people thirty-six years later had increased vascular dementia and Alzheimer's disease. Overweight was correlated with larger waists and poor cognition a dozen years later in the Framingham Heart Offspring Study. There is a more rapid brain aging. Overweight also correlates with cancer, heart disease, stroke, and diabetes.

7. Exercise
In the Nurses' Health Study at Harvard, 16,000 women had cognition tests, and those who exercised with increased physical activity had better test scores. They estimated aging two to three years faster. Those who were most active had better test scores (a half hour a day of brisk walking, but even slower walking was found to reduce the risk {Grodstein}).
Exercise helps lower blood pressure, insulin resistance, and thus potentially healthier arteries.

8. Controlling blood pressure
Increased blood pressure is related to heart disease and mini-strokes. There is no proven link to Alzheimer's disease thus far. Of note is that with Alzheimer's disease, there is a decrease in blood pressure, cholesterol and weight.

In middle age, increased blood pressure, weight and cholesterol are risk factors not only for heart disease but dementia. In a Finnish study (1,450 middle-aged men and women), those with high blood pressure had twice the risk of Alzheimer's disease and dementia.

9. Cognitive brain stimulation
There is a decreased risk in Alzheimer's disease and dementia in older people, who do intellectually stimulating work. Going to museums, the library, concerts, attending classes or lectures, playing chess or writing letters and articles appear to be important. Higher education appears to promote better cognition. Those with Master's and Doctor's degrees do better than those with a Bachelor's degree (Grodstein).

Thus, brain exercises appear to be protective. The environment in which you live can also make a difference in brain stimulation. Training for a more active brain (ten sessions) of memory, reasoning and speed processing appear to be positive (Reference: JAMA, 296: 2805, 2006).

10. The role of depression
Yaffe notes that depression may play a prominent role associated with dementia. Those with serious depression did worse on their cognitive testing.
Classical symptoms of depression - a feeling of worthlessness, helplessness, boredom, fearful, hopeless or that life appeared to be empty. Fatigue (feeling tired), lack of appetite, and insomnia are less common symptoms in older people.
Being depressed affects your thought process. Studies are being contemplated to test depression and cognitive function in those taking anti-depressive medicines.
Not all aging people feel either miserable or depressed. Treating depression may also improve quality of life.

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