Tag Archives: diabetic

Genes, Alzheimer’s Disease and Your Choice

PET scan of a human brain with Alzheimer's disease

Image via Wikipedia

New genes have been discovered that seem to be linked to Alzheimer’s Disease (AD).  AD currently affects over 5 million Americans and that number is expected to increase substantially by the year 2029.

This year the first baby boomers will reach their 65th birthdays. By 2029, all baby boomers will be at least 65 years old.  Ninety-five percent of all AD is in people 65 and older.

The discovery of new genes linked to AD is a step in the right direction.  Every bit of information that help scientists unlock the mystery of why this occurs puts us closer to being able to effectively treat AD.

Let’s pretend that we know every gene that is involved in the production of AD.  Let’s also pretend a test that exists to specifically detect all of these genes in you.  Would you want to find out?  What would you do if you had all of the genes linked to AD?

The truth of it is, there is nothing you could do to change your genes.  Your genes are your genes.  They are there and you can’t remove them.  What you can do, however, is change how they are expressed.  Just because a person has a specific gene does not mean it has to be expressed.  The expression of many of our genes is closely related to our environment.  Diet, exercise, smoking, pollution and stress are just a few things that can negatively or positively affect the expression of our genes.

So back to my first question.  What would you do if you had all the genes linked to AD?  You can’t change your genes, but you can change your risk factors.

There are many known risk factor that increase the risk of AD, independent of your genetic potential.  The number one risk is aging.  Unfortunately, there isn’t much that can be done about that.  We are all going to get older which is not necessarily a bad thing.  It is much better than the alternative!

Known risk factors for AD that are controllable are as follows:

You will notice that these risk factors significantly overlap with one another.  You will also notice that when you control one risk factor you will impact another.  If you can control these risk factors in your life you will significantly reduce your risk of developing AD regardless of your genetic potential.
Cardiovascular health is perhaps the most important.  Cardiovascular disease causes a chronic, low grade reduction in blood delivery to the brain.  This is known as hypoperfusion.  This hypoperfusion is responsible for protein synthesis defects that later result in the classic AD neurodegenerative lesions.

To keep your cardiovascular system as healthy as possible make sure you eat an anti-inflammatory diet and exercise.  Fish oil is also something you should consider.  Fish oil, which contains omega-3 fatty acids, has been shown to reduce cardiovascular disease mortality better than any other substance known.

Reduction of high blood pressure is also very important.  When blood pressure is too high it fuels a kind of scarring linked to later development of Alzheimer’s disease and other dementias.  Controlling your blood pressure is actually very simple.  You must maintain a healthy weight first and foremost.  This, of course, means diet and exercise.  Increasing waistlines mean more tissue and blood vessels for your heart to push blood through. This puts a strain on the heart and increases the resistance the heart must push against.

Keeping a healthy cholesterol profile is essential.  However, the traditional tests from your doctor are probably not enough to tell whether you are at risk or not.  Traditional tests examine total cholesterol, HDL (“good”), LDL (“bad”) and triglycerides.  These are of some value, but they don’t tell the whole story.  What you must find out is the particle size.  In a nut shell, large and buoyant molecules of cholesterol are not as problematic as small and dense particles.  Your traditional test does not distinguish between the two.  Your traditional test might look very good, but a more advanced test may show that you are still very much at risk.  See my blog entry from last summer for more detailed information.

Diabetes is also extremely important to control.  Some references are referring to Alzheimer’s as Type III diabetes because of the biochemical similarities. Even being borderline diabetic raises the risk of developing Alzheimer’s or dementia by 70%!  Diabetes’ hallmark is high blood sugar.  This high blood sugar leads to a phenomenon called advanced glycation end products or AGEs.  AGEs adversely affect the structure and function of proteins. In combination with oxidative stress brain function is easily affected.  Advanced glycation end products have been found to be much more prevalent in the brains of Alzheimer’s patients than in healthy controls. This process begins early on in the course of Alzheimer’s and there is also evidence that AGEs assist in the formation of plaques seen in AD.  Diet and exercise are the best ways to prevent diabetes and reduce your risk of AD.

While the study for a purely genetic link to AD will continue, a cure is likely many years away if one can even be found.  What we can control, however, are our lifestyle choices that activate our genes.  If we choose poorly, we are much more likely to activate unfavorable genes that cause disease.  If we choose wisely, we are more likely to activate genes that are favorable and reduce our risk of further disease.  The choice is yours.  Make the right one.

Leave a comment

Filed under Brain Health

Solving Childhood Obesity – Part I

Recently released this month was an interesting piece on childhood obesity.  It is part of the Let’s Move campaign that is headed by First Lady Michelle Obama.  The report entitled Solving the Problem of Childhood Obesity within a Generation is full of good information (full report available at www.letsmove.gov).  I am usually skeptical of such reports because they seem to just recycle to same old information that has gotten us into the problem in the first place.  This report seems to be different.  Over the next couple of weeks, I am going to try and break down most of the recommendations that were put forth in this new report. Some of the recommendations I find very refreshing.  They are often things chiropractors, naturopaths and nutritionists have been recommending for years.  I’m glad to see traditional medicine catching up.

I have spoken many times on this blog about childhood obesity and what a large problem it is in the US.  The numbers are staggering.

  • One in every three children (31.7%) ages 2-19 is overweight or obese.
  • Obesity is estimated to cause 112,000 deaths per year in the United States, and one third of all children born in the year 2000 are expected to develop diabetes during their lifetime.
  • The current generation may even be on track to have a shorter lifespan than their parents.

Also, this takes a massive toll on our health care system.  As health care costs continue to rise many economists say that they could eventually bankrupt the country.  Each year, obese adults incur an estimated $1,429 more in medical expenses than their normal-weight peers.  Overall from 1998 to 2008 medical costs related directly to obesity in adults increased by almost four fold from $40 billion to over $147 billion.  Childhood obesity now contributes to $3 billion in medical costs.

Unfortunately the trends of obesity are continuing to rise and have risen substantially in the last 30-40 years.  In particular, the levels of obesity have increased significantly since 1980.  Obesity has more than doubled among adults (rising from 15% to 34%), and more than tripled among children and adolescents (rising from 5% to 17%) since 1980.

While most people know that being overweight increases the likelihood of heart disease, there are other problems associated with it as well.  Obesity increases the risk of cancer, diabetes, arthritis, depression and osteoporosis to name a few.  Quality of life is also affected.  Children who are obese report a lower health-related quality of life (a measure of their physical, emotional, educational, and social well-being). One study actually found that children who are obese have similar quality of life as children with cancer!

So the question is how do we solve the problem?  The first part of the solution might surprise you.

Breastfeeding

Children who are breastfed are at reduced risk of obesity.77 Studies have found that the likelihood of obesity is 22% lower among children who were breastfed. This effect was noted all the way into adolescence suggesting that breastfeeding your child has very long lasting effects.  Other studies have shown that for every month a child is breastfed up to 9 months, a 4% reduction in the risk of being obese is observed.

In my practice I recommend that my patients breastfeed up to 12 months if possible.  Routinely I hear from expectant or new mothers that their doctors ‘recommend’ breast feeding but that they won’t lose out on anything if they choose formula.  This may stem from the years when women were being told that breast milk was no match in terms of nutrients to what could be concocted in a lab.  It is clear now that breastfeeding is an important part of the early life of a child.

Even though the research clearly points out that breastfeeding is critical most children (67%) do not breastfeed after three months.  The protection offered by breast milk is from several factors.   First, synthetic formulas contain twice as much protein as breast milk.  This stimulates insulin to be secreted in amounts that are too high.  This leads to excess fat storage.

Second, the biological response to breast milk differs from that of formula. When feeding a baby, the mother’s milk prompts the baby’s liver to release a protein that helps regulate metabolism.  This is not produced with formula.  Also,  giving formula is associated with unfavorable concentrations of leptin, a hormone that inhibits appetite and controls body fatness.

So why don’t more women breast feed? It is a complicated answer that has physical, social and cultural factors.  However, in this country we don’t make it easy for new mothers.  In the hospital a newborn is often taken from their mother and necessarily given formula.  This makes it difficult for the baby and the mother to learn how to properly breastfeed.  Part of the solution is to designate hospitals as “baby friendly” as determined by an independent group appointed by the government.  A hospital is given this baby friendly designation if they meet certain criteria for breastfeeding.  Currently, only 3% of births occur in baby friendly hospitals.

My advice to patients is always to breastfeed.  Do everything you can to make sure it happens.  If any doctor tells you that formula is ‘just as good’ as breast milk, find another doctor.  If you cannot breastfeed directly, try and pump your breast milk.  The advantages of breast milk over formula are huge.  After all a million years or so of evolution can’t be wrong.  In my next blog we will talk about chemical exposure and screen time and how it relates to childhood obesity.  I hope you’ll continue to read.

1 Comment

Filed under Diet, Public Health

Drugs shown to have no benefit (and some risks) for diabetics

The results of a new study in diabetics has shown that adding drugs to drive blood pressure and blood-fats lower than current targets did not prevent heart problems, and in some cases caused harmful side effects.  This study was launched 10 years ago by the federal government to see if lowering blood sugar, blood fats or blood pressure would reduce heart attacks and strokes in diabetics.  The results showed that the drugs had no effect on reducing incidence of heart attack or stroke and for some caused serious side effects.

The results were called ‘disappointing’ but from my perspective this couldn’t be better news.  Had this study had positive outcomes it would have given another reason why every diabetic should be on more drugs to ‘protect their hearts.’

The studies were presented Sunday at an American College of Cardiology conference and published on the Internet by the New England Journal of Medicine.

They involved people with Type 2 diabetes — the most common form and the one rising because of the obesity epidemic. Diabetics have more than double the risk of dying of heart attacks or strokes than people without the disease.

The first piece of the study — about blood sugar — was stopped two years ago, when researchers saw more instead of less risk with that approach.

For the blood-fat study, researchers led by Columbia University’s Dr. Henry Ginsburg recruited more than 5,500 diabetics who also had another health risk, such as high blood pressure or cholesterol.

All were given a statin — cholesterol-lowering pills sold as Lipitor and Zocor.  Half also were given Abbott Laboratories’ blockbuster drug, TriCor; the rest got dummy pills. TriCor is a fibrate, a drug that lowers blood fats called trigylcerides while boosting “good” cholesterol.

Nearly five years later, the groups had similar rates of heart attacks and strokes.

The blood-pressure part of the study was led by Dr. William Cushman, preventive medicine chief at Veterans Affairs Medical Center in Memphis, Tennessee. About 4,700 diabetics were treated with various medicines to keep their systolic blood pressure — the top number — either below 140 or below 120.

The intense treatment did not reduce the number of heart attacks, although it prevented more strokes, a less common problem. Side effects were greater with the intense treatment.  (Excerpt from usatoday.com)

The question raised in the article I read was ‘what should diabetics do then?’  First of all, they ask this question like medication is the only answer for these people.  Many millions of people have type II diabetes or are on their way to having it.  The first thing that should be done is avoid the disease in the first place.  Type II diabetes is not a disease in the classic sense.  It is no more a disease than obesity is a disease.  It can be avoided with a healthy lifestyle.  Proper nutrition should be a class in school just like science or math.  The fact that children learn more about the planet Mars than they do about how to truly eat nutritiously is ridiculous. I am not suggesting the sciences are not important, but I bet most kids couldn’t tell you the difference between a carbohydrate, a fat and a protein other than ‘fat is bad for you’ (which is wrong anyway).  True nutrition in which carbohydrates are emphasized less and healthy fats are emphasized more would go along way to reducing the health care crisis in this country.  The low fat paradigm will not work because it is inconsistent with human physiology.

I am not so naive to think that if children were educated from a young age about health and nutrition that we could prevent every case of type II diabetes.  With that said ‘what do diabetics do then?’  They change their lifestyles immediately upon diagnosis. It’s as simple as that.  I have many patients who have been diagnosed with type II diabetes and we routinely improve their outcomes with diet and supplementation.  The solution is simple; change the diet to a low carbohydrate diet, increase exercise and support them with supplementation designed to increase insulin sensitivity.  The trick is not to lower blood sugar intensely (as this study’s goal was) it is to change their hormonal picture.  While on our program blood sugar levels do decrease because of the diet but the real change is insulin regulation.

In the article I read the answer to the question ‘what do diabetics do?’ was answered by what most would consider a prominent physician.  He said:

Focus on healthy diets and lifestyles, and take tried-and-true medicines that doctors recommend now to control health risks, said several experts, including Dr. Clyde Yancy, a Baylor University cardiologist and president of the American Heart Association.

I agree totally with the first part of the statement although I am sure the “diet” he is referring to is of the low fat variety which will not work for diabetics.  Diabetes is a disease (an I use ‘disease’ lightly) of carbohydrate metabolism.  Eating a low fat diet forces one to eat more carbohydrates.  Where is the logic in that!?

The second part of the statement is completely and totally ridiculous.  He tells us we should use “tried-and-true medicines that doctors recommend now to control health risks.”  The medications used in this study are the very drugs that almost every medical physician in this country would call “tried and true ways” to reduce cardiovascular disease.  Find me a medical physician who has any answer besides medication Lipitor or Zocor for lowering cholesterol and I’ll be surprised.  They did not make mention of the specific drugs they used to lower blood sugar or blood pressure but I am sure they are the common ones I see everyday in practice.  A statement like the one from Dr. Yancy simply doesn’t make sense in the context of what was studied.

Type II diabetes is a disease almost exclusively brought on by years of dietary indiscretions.  The fix is not drugs and this study shows that.  The fix is diet and lifestyle modification in which people significantly reduce carbohydrate consumption and begin to exercise.  Doing this improves health outcomes and has no side effect to worry about.  Depending on chemicals to do the job for you won’t work.

Leave a comment

Filed under Diet, Public Health