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Posts Tagged Alzheimer’s

Vitamin E for Alzheimer’s

Recently you may have seen headlines like “Vitamin E slows decline in patients with mild Alzheimer’s” or “There’s still no cure for Alzheimer’s disease, but the latest hope for slowing its progression is already on drugstore shelves.” They were referring to an article in the January 1, 2014 issue of the Journal of the American Medical Association (JAMA) announcing the results of the TEAM-AD VA Cooperative Randomized Trial of vitamin E and memantine (Namenda) for Alzheimer’s disease (AD).

The study attracted a lot of media attention. Most of the news reports I have seen were accurate and cautious, explaining the nuances of the study rather than suggesting that everyone should run out and buy vitamin E; but I wouldn’t be surprised to learn that a lot of readers ignored the fine print and did just that. It would be interesting to track sales of vitamin E and see if there was a bump following the publicity.

We know of no treatment that will delay, prevent or cure Alzheimer’s disease, or that affects the underlying disease process. It’s a tragic, frustrating disease that takes away the very things that make us who we are: memory and personality. It is affecting more and more people as the numbers of elderly increase. Available prescription medications are only modestly effective in slowing functional decline and delaying the need for institutionalization. They are expensive, they don’t help everyone, and when they do help, they only help for a limited time. It is very exciting to think an inexpensive vitamin could help patients with mild to moderate AD, but we must resist the temptation to read too much into this study. (more…)

Posted in: Clinical Trials, Herbs & Supplements, Neuroscience/Mental Health

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Coconut Oil

In a former life, when I was an Air Force doctor, one of my duties was to give “Healthy Heart” briefings with a script furnished by Air Force experts. It covered the scientific consensus of the time (the early 80s) about diet. It recommended a low fat diet, restricted cholesterol and saturated fat, and demonized tropical oils like palm oil and coconut oil. (Trans fats weren’t yet on the agenda.)

Times have changed. Today we are more lenient about cholesterol in the diet, less concerned about total fat and saturated fat, and more concerned about trans fats. While many major health organizations still discourage its use, coconut oil has not only been rehabilitated in the public mind, but all kinds of health benefits are being claimed for it.

The fats in coconut oil
Coconut oil is high in saturated fats; it contains more saturated fatty acids than any other non-hydrogenated oil. It is stable and has a long shelf life. It is used in movie theaters to pop popcorn and in South Asian cuisine for dishes like curries. A hydrogenated version of coconut oil is an ingredient in non-dairy creamers. Much of the research done on coconut oil studied hydrogenated or partially hydrogenated forms. According to an article in the New York Times:

Partial hydrogenation creates dreaded trans fats. It also destroys many of the good essential fatty acids, antioxidants and other positive components present in virgin coconut oil. And while it’s true that most of the fats in virgin coconut oil are saturated, opinions are changing on whether saturated fats are the arterial villains they were made out to be. “I think we in the nutrition field are beginning to say that saturated fats are not so bad, and the evidence that said they were is not so strong,” Dr. Brenna said.

Coconut oil contains lauric acid, which raises both HDL and LDL cholesterol levels. This may improve the cholesterol profile, although there are concerns that it may promote atherosclerosis by other means. Virgin coconut oil contains medium-chain triglycerides, which are not as risky as some other saturated fats.
(more…)

Posted in: Herbs & Supplements, Nutrition

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Steven Fowkes (Part 2 of 2): Nutrients for Better Mental Performance

Last week, in part 1, I covered Steven Fowkes’ “cures” for Alzheimer’s and herpes. In part 2, I will cover a video where he goes further afield. It is titled “Nutrients for Better Mental Performance,” but he also discusses sleep, depression, hangovers, and a lot of other topics.

Some of what he says are simple truisms: mental performance is affected by everything related to health such as sleep, food, vitamins, minerals, detoxification, nutrients, amino acids, hormone replacement, pharmaceuticals and herbs. Metabolism is the key to brain function: 3% of the body uses 20% of the energy. Macronutrients, micronutrients, exercise, water, and breathing are important too.

We knew that.

Which nutrients promote optimal brain function? All of them: any deficiency will affect the brain. Fowkes goes beyond the evidence to claim that some nutrients are needed at super-physiological levels; Mother Nature is not optimal. Some supplements appear to work but the effects are not sustainable. It’s not about parts, but about how things work together. (more…)

Posted in: Neuroscience/Mental Health, Nutrition

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Steven Fowkes (Part 1 of 2): How to Cure Alzheimer’s and Herpes

A correspondent asked me to review a video presentation by Steven Fowkes, “Nutrients for Better Mental Performance,” one segment of a 9-part series on preventing and curing Alzheimer’s that was mentioned recently by an SBM commenter. Fowkes is an organic chemist without a PhD; he says this means:

I am not institutionalized [This begs for a joke, but I will refrain.] and see the world differently. Everything I know I learned outside the system.

He is associated with CERI, the Cognitive Enhancement Research Institute and has written extensively on nutrition and health. I’ll comment on his claims for Alzheimer’s and herpes first, and then return to the “Nutrients for Better Mental Performance” video next week.

Alzheimer’s

He says he can prevent Alzheimer’s disease and cure it in the early stages, although later damage will not be reversible. And yet he doesn’t actually specify the details of how he accomplishes that miracle: apparently it’s complicated (I would imagine so) and varies with the individual. Science doesn’t know what causes Alzheimer’s, but Fowkes does. The current thinking of scientists is that it is due to genetic factors interacting with environmental factors, and it might be a natural consequence of the aging process that would eventually affect anyone who lives long enough. Fowkes says it involves a complicated domino cascade of effects, but the cause boils down to loss of glutathione cycling and failure of sulfhydryl enzymes, which  interferes with the detoxification of mercury in the brains of Alzheimer’s patients. (more…)

Posted in: Herbs & Supplements, Neuroscience/Mental Health

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Do Cell Phones Prevent Alzheimer’s?

Scientific studies are not meant to be amusing, but I laughed out loud when I heard about this one. After all the concern about possible adverse health effects from cell phone use, this study tells us cell phone use can prevent Alzheimer’s, treat Alzheimer’s, and even improve cognitive function in healthy users.

They studied transgenic mice programmed by their genes to develop Alzheimer’s-like cognitive impairment; they used a group of non-transgenic littermates as controls. For an hour twice daily over several months they exposed the entire mouse cage to EMF comparable to what is emitted by cell phones. They tested cognitive function with maze tests and other tasks that are thought to measure the same things as human tests of cognitive function. The authors claim to have found striking evidence for both protective and disease-reversing effects. (more…)

Posted in: Neuroscience/Mental Health

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Don’t Believe The Hype: Cholinesterase Inhibitors As A Treatment For Dementia

Don’t Believe The Hype: Cholinesterase Inhibitors As A Treatment For Dementia
I distinctly remember the day I attended a “drug lunch” (as a PM&R resident in New York City) to learn about the value of donepezil (aricept) for the treatment of dementia. I was astonished by the drug’s lack of efficacy – the graph displayed in the PowerPoint show demonstrated a 2-point improvement on the Mini Mental State Exam (MMSE), an effect that began after 6 months of donepezil use, and persisted for only 6 months after that. A 2-point difference on the MMSE has no clinical relevance of which I’m aware. The drug’s common side effects include: nausea, vomiting, diarrhea, loss of appetite, tiredness, drowsiness, trouble sleeping, or muscle cramps. That day I vowed never to prescribe the drug to my elderly patients.
Nonetheless, I was dumbfounded by the number of patients who came to the hospital already on the medication. Over and over again I heard the same story: “mom is becoming forgetful so our doctor started her on this medication to help her memory.”
When I asked if the family if they thought the medicine helped, the response was equally predictable: a shrug and then “what else can we do?”
Here we have a classic example of a medical problem with no satisfactory treatment or cure – and a desperate desire on the part of patients and family members to do something – anything – about it. Many times people in these predicaments turn to alternative medicines, herbal supplements and faith –based remedies. And sometimes they turn to FDA-approved drugs.
The Cochrane Collaborative has reviewed the scientific literature on the use of cholinesterase inhibitors (like donepezil) in mild dementia, and has found:
There is no evidence to support the use of donepezil for patients with mild cognitive impairment (MCI). The putative benefits are minor, short lived and associated with significant side effects. http://www.cochrane.org/reviews/en/ab006104.html
So how did this drug get approved? Well, there do seem to be some small improvements (of dubious clinical significance in my opinion) in measures of cognitive impairment in patients with Alzheimer’s dementia in particular. http://www.cochrane.org/reviews/en/ab005593.html
AHRQ states:
The evidence is mixed, however, about the effects of cholinesterase inhibitors on functional measures such as instrumental activities of daily living (i.e., ability to use the telephone, mode of transportation, responsibility for medication, and ability to handle finances). In general, the studies show little or no effect on functional decline after 6 months of treatment and a small but statistically significant difference from placebo after 12 months of treatment.
Research has found no clinically important differences between people taking cholinesterase inhibitors and those taking placebo in the development of behavioral and psychological symptoms… Studies rarely addressed other important health outcomes such as utilization of health care services, injuries, and caregiver burden.
http://www.ahrq.gov/clinic/3rduspstf/dementia/dementsum.htm
Pfizer’s press release (when they received FDA approval to market Aricept in 1996) noted:
Alzheimer’s disease is a family tragedy. ARICEPT will benefit patients and families alike by improving or maintaining patient function, which in turn may help ease the burden for caregivers and help maintain personal dignity… “ARICEPT represents a significant step forward in addressing the therapeutic needs of the Alzheimer’s disease community…This therapy will help to change the approach to the management of Alzheimer’s disease.
http://www.pslgroup.com/dg/e2aa.htm
Global sales of Aricept were approximately $1.1 billion for 2008 alone.
Me-too cholinesterase inhibitors have seen similar global profits, with sales of namenda at about $1 billion as well in 2008. http://www.businessweek.com/magazine/content/04_14/b3877629_mz073.htm All this while the AHRQ can find no clinically relevant difference between the drugs in this class, and the effects they have are small and short lived.
There are pharmaceutical innovations that have changed the course of history (imagine where we’d be without the polio or smallpox vaccines), while others leverage the tiniest statistically-significant effects to drive global drug empires driven by public feelings of helplessness in the face of currently incurable diseases.
It’s no wonder that the public has a mistrust of pharma – their marketing engines drive sales of drugs that have vastly different clinical value. That means it’s up to physicians and scientists to tease out the legitimate enthusiasm from the marketing hype. And judging from all the patients with mild dementia that I see on cholinesterase inhibitors, I give us a failing grade.

I distinctly remember the day I attended a “drug lunch” (as a PM&R resident in New York City) to learn about the value of donepezil (Aricept) for the treatment of dementia. I was surprised by the drug’s lack of efficacy – the graph displayed in the PowerPoint show demonstrated a 2-point improvement on the Mini Mental State Exam (MMSE), an effect that began after 6 months of donepezil use, and persisted for only 6 months after that. A 2-point difference on the MMSE has no clinical relevance of which I’m aware. The drug’s common side effects include: nausea, vomiting, diarrhea, loss of appetite, tiredness, drowsiness, trouble sleeping, or muscle cramps. That day I realized that the risk-benefit profile did not support its use.

Nonetheless, I was perplexed by the number of patients who came to the hospital already on the medication. Over and over again I heard the same story: “Mom is becoming forgetful so our doctor started her on this medication to help her memory.” (more…)

Posted in: Pharmaceuticals

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