No, fish oil isn't as multipurpose as Windex...it's still about overall lifestyle

I am devoting this blog post to my friends who think I've gone fish oil overboard! I write and talk about fish oil so much, it seems, they've gotten the impression that maybe I've forgotten about all of the other things that determine health. One of my neighbors constantly teases me about the fact that I believe in and promote fish oil like the guy who uses Windex for everything in the movie My Big Fat Greek Wedding. Colleague Karen Siegel (Houston registered dietitian and licensed acupuncturist) sent me the following article.

Note that the recommendations at the end of this quote are the same recommendations commonly made for diabetes prevention--and you HAVE seen in this blog, that I have written on the connection between diabetes and Alzheimer's disease.

It's not that I think fish oil can replace a healthy lifestyle, it's that I see so many people who pretty much have the right idea, and not balancing omega-3's is the piece that keeps them from being completely on the right train.

Though I do believe fish oil is important, this article perfectly sums up how I do feel: by no means is fish oil a "bad habit eraser"! You've got to live a healthful life, and when you do that, fish oil may help decrease your health risk.

Oh, BTW, that neighbor who teases me? She told me the other day she secretly went to Costco and got the pills...and her hair and nails have started to become longer and stronger.

Dangour AD, Allen E, Elbourne D, Fletcher A, Richards M, Uauy R. Fish Consumption and Cognitive Function among Older People in the UK: Baseline Data from the Opal Study. J Nutr Health Aging. 2009;13(3):198-202.


A UK study has cast doubt on claims that eating oily fish can protect against dementia in old age.

Data from a trial of more than 800 older people initially showed that those who eat plenty of oily fish seem to have better cognitive function.

But factors such as education and mood explained most of the link.

Researchers need to clarify what, if any, benefits fish oil has on the ageing brain, they wrote in the Journal of Nutrition, Health and Ageing.

In recent years, there has been increasing interest in diet as a way of preventing dementia.


It's not at all clear that healthy older people get any benefit from eating fish oil

Dr Alan Dangour, study leader
Much focus has been on omega 3 fatty acids found in oily fish, such as salmon and mackerel.

And there are biological reasons, backed by tests in the laboratory, why in theory, these fatty acids would be neuroprotective.

The latest study found a significant association between eating a couple of portions of fish a week and better scores on tests of cognitive function.

But when the researchers, from the London School of Hygiene and Tropical Medicine, took into account education and psychological health the association almost disappeared.

Healthy

Experts advise eating a couple of portions of fish a week, with at least one being an oily fish, because there are proven benefits on the heart.

Study leader Dr Alan Dangour said claims about the benefits of oily fish in warding of dementia in older people seemed to have been oversold.

"The evidence on this has always been sporadic.

"What this shows is there is a link between people who eat oily fish and better cognitive function, but if you adjust for education and mood this relationship goes, so it's not at all clear that healthy older people get any benefit from eating fish oil."

The evidence collected by Dr Dangour was for a study due to report later this year comparing fish oil supplements with placebo.

He added that this randomised, controlled study should provide clarification.

Neil Hunt, chief executive of the Alzheimer's Society, said: "One of the best ways to reduce your risk of dementia is by eating a Mediterranean diet rich in fruit, vegetables, grains, fish and poultry.

"However, we still do not know which components of this sort of diet help the most.

"Unfortunately this study does not add to our understanding.

"Once age, sex and education are accounted for the research does not show any significant benefit of regularly eating oily fish."

Nutritional compounds with promise in Alzheimer's syndrome

Anyone experiencing Alzheimer's disease firsthand probably has wondered if there is any extra "edge" they might obtain for their own risk from nutritional supplementation. A group of researchers recently reported that a combination supplement reduced the levels of already existing specific oxidative marker levels by 57% and prevented the reappearance of new molecules.

The supplement used in this study contained the following compounds: alpha-lipoic acid, acetyl-l-carnitine, glycerophosphocoline, docosahexaenoic acid (DHA), and phosphatidylserine.

I don't know about you, but this is one condition I'd rather not give a head start to my brain, and one I'm happy to be proactive when it comes to my current supplemental choices.

Suchy J, Chan A, Shea TB. Dietary supplementation with a combination of alpha-lipoic acid, acetyl-L-carnitine, glycerophosphocoline, docosahexaenoic acid, and phosphatidylserine reduces oxidative damage to murine brain and improves cognitive performance. Nutr Res. 2009 Jan;29(1):70-4.

Alzheimer's, sleep, and diabetes--three very interesting amigos

I didn't realize until reading this abstract that Alzheimer's disease affects sleep patterns as well as memory. It makes sense, since adequate sleep is necessary in order to retain memory of information gained during the day.

The medication reviewed in this article is galantamine (Reminyl), and the authors suggest that it is important to time medication administration in order to gain maximum effectiveness and sleep. And, that certain medications help (and interfere with) sleep more than others.

Disrupted sleep can worsen diabetes. Since many people with Alzheimer's also have diabetes--in fact, the two diseases are starting to be recognized as being very strongly linked to each other--this connection between sleep and medication can be very important to understand.

My guess is that if you are on this blog looking for information about Alzheimer's, it is a loved one, not you, that the information is for. Here is the bottom line:
1. If your loved one had problems with sleep before being recommended or placed on medication, it might be a good idea to check with the prescribing physician to be sure this was taken into account when choosing which Alzheimer's medication to prescribe.
2. If your loved one has developed changes in sleep habits since starting an Alzheimer's medication, be sure to let the prescribing physician know.
3. If your loved one's diabetes has become worse despite diligent attention to medications and food intake, consider the influence of sleep or lack thereof.
4. Be sure to ask your physician and/or pharmacist if there is a time of day your particular medication needs to be taken for maximum effectiveness.

Nieoullon A, Bentué-Ferrer D, Bordet R, Tsolaki M, Förstl H. Importance of circadian rhythmicity in the cholinergic treatment of Alzheimer's disease: focus on galantamine*. Curr Med Res Opin. 2008 Dec;24(12):3357-67.

And I thought I was happy after eating at Delhi Palace because the food was so good!

Turmeric is a spice commonly used in Indian cooking that is gaining attention for its health properties. Curcumin, the ingredient in turmeric that provides its yellow color, is thought to be a very powerful antioxidant and anticancer agent.

In Alzheimer's patients, not only can it prevent the accumulation of destructive beta-amyloid proteins, but it is thought to even break up already existing plaques (when I saw this, it made me wonder if this is why the oldest man in the world always seems to be living in some small Indian village.)

Now it's looking like curcumin may also have antidepressant properties. When tested on rats, it had activities mimicking that found in three different categories of antidepressants--monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, and dopamine reuptake inhibitors. Specific medications it was compared to included fluoxetine (Prozac), venlafaxine (Effexor), and bupropion (Wellbutrin).

When rats were already on medication, curcumin seemed to enhance the activity of the medication. Which has me thinking that psychiatrists should be handing out coupons to the closest Indian restaurant along with their medication scripts.

It appears that curcumin absorption is better in the presence of piperidine, a component of black pepper. Curry powder, readily available in most grocery stores, is a combination of coriander, cumin, black pepper, white pepper, turmeric and chillies). Not a bad item to keep stocked in your mental health cooking arsenal.

If you like to cook, Indian food is fun and easy. To get you started, here's a link to some curry recipes. Be sure you cook with olive or canola oil to get the best brain bang for your buck.

Kulkarni SK, Bhutani MK, Bishnoi M. Antidepressant activity of curcumin: involvement of serotonin and dopamine system. Psychopharmacology (Berl). 2008 Dec;201(3):435-42. Epub 2008 Sep 3.

Yang, F; Lim GP; Begum AN; Ubeda OJ; Simmons MR; Ambegaokar SS; Chen PP; Kayed R; Glabe CG; Frautschy SA; Cole GM (February 2005). Curcumin inhibits formation of amyloid beta oligomers and fibrils, binds plaques, and reduces amyloid in vivo. Journal of Biological Chemistry (American Society for Biochemistry and Molecular Biology) 280 (7): 5892–901.

Fatty aspirin: a new perspective in the prevention of dementia of Alzheimer's type?

One of the reasons many nutritional therapies don't get much research attention is that research studies need to be funded. And the biggest bank accounts to be accessed for those funds are those held by companies who can get a return on their investment for supporting that research. In other words, if a company can invest research in a project that results in a chemical that can be patented and sold at a profit, there's a motivation to spend money in that way.

You can't patent a salmon.

And if you saw the way my pecan farming friends managed their businesses here in Arizona...a few pecans here, a bed and breakfast there...not really multi-million dollar enterprises.

So it makes sense that some of the best answers to medical problems are likely not going to show up in medical journals. For all their good intent and peer reviews, these journals are often promotional venues for the companies funding the studies they report on. Those promotions just aren't formatted as advertisements.

But I always wonder when reading all these studies, why the Reese's Peanut Butter Cup Effect hasn't happened. What I mean by that is, if there is a little bit of (very strong) evidence to support natural remedies such as fish oil and herbs, why these drug companies don't come up with combinations of supplements and medications that (1) increase the effectiveness of the treatment, (2) reduce the side effects that minimize drug compliance, like weight gain, and (3) engage the interest of people who don't necessarily want to take medications but might consider them if the natural remedies they DO trust were somehow incorporated into the treatment? Just like the old, "You got chocolate in my peanut butter" ads.

Here is a reference for such a combo, a "fatty aspirin", or fish oil-aspirin combination, that could be used to delay the development of Alzheimer's disease.

OK, in that case I can't say you heard it here first, but when you guys start coming up with fatty antipsychotics, fatty antidepressants, yadayada...and you know it's eventually going to happen...you know where to send the royalty check!

Pomponi M, Di Gioia A, Bria P, Pomponi MF. Fatty aspirin: a new perspective in the prevention of dementia of Alzheimer's type? Curr Alzheimer Res. 2008 Oct;5(5):422-31.

Weight change in Parkinson and Alzheimer patients taking atypical antipsychotic drugs.

As much trouble as I have with indiscriminate use of antipsychotic medications, I do think they have important uses in certain situations, and that we have to be very careful about overgeneralizing their negative aspects.

For example, these medications are increasingly being used to help control side effects in some serious illnesses such as Parkinson's disease and Alzheimer's disease. In some cases, especially when not managing these side effects can make things hard to manage for these individuals' caregivers (who are often family in a home situation), it is important to balance considerations about overall quality of care, caregiver sanity and health, and weight. Each situation is different, and there are no easy answers.

Sixty-one Parkinson's patients on either quetiapine (Seroquel) or clozapine (Clozaril) for at least six months were compared to 28 Alzheimer's patients in similar situations. The weight changes, though small, were statistically significant. Parkinson's patients trended toward weight loss compared to controls, and Alzheimer's patients trended toward weight gain.

It may not be that these medications cause weight changes in one direction or the other...but rather, they foster metabolism moving in a direction that genetic tendency long ago pre-programmed. It is important to not be afraid of a medication that can help ease the life of the caregiver. Of course, judicious use and close monitoring are always the caveats that go with any medication decision. Alzheimer's patients seem to be prone to developing diabetes and that should not be ignored.

I was glad to see this study attempt to parse out exactly what these medications do and why. That's a great use of scientific minds.

Sitburana O, Rountree S, Ondo WG. Weight change in Parkinson and Alzheimer patients taking atypical antipsychotic drugs. J Neurol Sci. 2008 Sep 15;272(1-2):77-82. Epub 2008 Jun 16.

Your brain loves lipoic acid!

I'm primarily a food first, supplements second kind of person. However, lipoic acid is a supplement I love to recommend. It's not something that you can readily find in food, but it does a whole lot of good, especially in the brain.

It can delay and prevent Alzheimer's disease, and dementia, in a variety of ways. It helps to increase acetylcholine levels. Acetylcholine is the neurotransmitter in charge of memory function. It helps to bind free radicals, preventing them from doing damage. It prevents the formation of proteins associated with inflammation.

Not a bad friend, is it?

The amount given in the two studies evaluating lipoic acid's effect on the brain was 600 mg per day.

Lipoic acid is also unique in that it has the ability to make other antioxidants more powerful. The authors of the article reviewed here suggested that in combination with curcumin, EGCG (active ingredient in green tea), and DHA (in fish oil and marine algae), lipoic acid could be a very powerful warrior in the fight against degenerative brain disease.

Hmmmm...anyone for some fish curry, with a green tea chaser?

Maczurek A, Hager K, Kenklies M, Sharman M, Martins R, Engel J, Carlson DA, Münch G. Lipoic acid as an anti-inflammatory and neuroprotective treatment for Alzheimer's disease. Adv Drug Deliv Rev. 2008 Oct-Nov;60(13-14):1463-70. Epub 2008 Jul 4.

Oh, the tangled web we weave, when science we manipulate in order for profits to achieve...

Oh, this story just won't go away.

Years ago, when olanzapine (Zyprexa) was fairly new to the market, my colleagues started commenting that they noticed huge weight gains (like 40-50 pounds) in short time intervals (like a month). No matter where we attempted to get information, Lilly, this drug's manufacturer, insisted that this drug did not increase weight gain.

I had the opportunity to meet one of Lilly's lead marketing guys at a national conference. We exchanged cards and when I got home I emailed him with a proposal that the team of nutritionists I was training in the area of psychotropic medications and hormone imbalances, work with Lilly to create a diabetes management educational program targeted specifically at psychiatrists, who were not specialized in this area but who appeared to need support in order to use these new medications in safe and appropriate ways.

I received an email in return, carbon copied to quite a few people at Lilly, stating that "weight gain on our medication is an unscientific rumor". (I now call this correspondence my "60 Minutes E-mail").

It wasn't 6 months before Lilly was required to put a black box warning on this very medication regarding its potential to cause diabetes. Apparently the timing of my original email struck a raw nerve.

What really bothered me about this whole situation was at the very time Lilly was insisting that that this drug did not cause weight gain, they were marketing it to eating disorder specialists as a treatment option for anorexia nervosa.

Yes, you heard me correctly. Lilly apparently wanted us to believe that the drug doesn't cause weight gain if you use it in people who don't want to gain weight, but it is very effective in causing weight gain in people who desperately need to gain weight.

Fast forward to last Friday. I'm scanning new research abstracts in Pub Med and right next to each other I see these two titles:

Olanzapine in the treatment of low body weight and obsessive thinking in women with anorexia nervosa: a randomized, double-blind, placebo-controlled trial.

Olanzapine (LY170053, 2-methyl-4-(4-methyl-1-piperazinyl)-10H-thieno[2,3-b][1,5] benzodiazepine), but not the novel atypical antipsychotic ST2472 (9-piperazin-1-ylpyrrolo[2,1-b][1,3]benzothiazepine), chronic administration induces weight gain, hyperphagia, and metabolic dysregulation in mice.

There is also, in Pub Med, research to suggest that this medication may trigger binge eating disorder.

So apparently, the newest, quickest way to cure anorexia is to replace it with another eating disorder. Never mind that it creates hormone imbalances that are strongly documented and have mandated a warning be placed on this drug.

I thought when we helped people with anorexia, they were supposed to be healthy in all respects. Not just normal weight with a risk of developing diabetes. Which, by the way, is starting to be associated with Alzheimer's disease.

Insert huge, frustrated, sigh...

Bissada H, Tasca GA, Barber AM, Bradwejn J. Olanzapine in the treatment of low body weight and obsessive thinking in women with anorexia nervosa: a randomized, double-blind, placebo-controlled trial. Am J Psychiatry. 2008 Oct;165(10):1281-8. Epub 2008 Jun 16.

Coccurello R, Caprioli A, Conti R, Ghirardi O, Borsini F, Carminati P, Moles A. Olanzapine (LY170053, 2-methyl-4-(4-methyl-1-piperazinyl)-10H-thieno[2,3-b][1,5] benzodiazepine), but not the novel atypical antipsychotic ST2472 (9-piperazin-1-ylpyrrolo[2,1-b][1,3]benzothiazepine), chronic administration induces weight gain, hyperphagia, and metabolic dysregulation in mice. J Pharmacol Exp Ther. 2008 Sep;326(3):905-11. Epub 2008 Jun 20.

Theisen FM, Linden A, König IR, Martin M, Remschmidt H, Hebebrand J. Spectrum of binge eating symptomatology in patients treated with clozapine and olanzapine. J Neural Transm. 2003 Jan;110(1):111-21.

Gebhardt S, Haberhausen M, Krieg JC, Remschmidt H, Heinzel-Gutenbrunner M, Hebebrand J, Theisen FM. Clozapine/olanzapine-induced recurrence or deterioration of binge eating-related eating disorders. J Neural Transm. 2007;114(8):1091-5. Epub 2007 Mar 20.

Kluge M, Schuld A, Himmerich H, Dalal M, Schacht A, Wehmeier PM, Hinze-Selch D, Kraus T, Dittmann RW, Pollmächer T. Clozapine and olanzapine are associated with food craving and binge eating: results from a randomized double-blind study. J Clin Psychopharmacol. 2007 Dec;27(6):662-6.

When it takes more than a minute to describe how many medications you're taking...time to take a closer look.

Yesterday I was lunching with a dear friend, who mentioned that one of HIS friends has started to have problems with diabetes. I knew this friend also has Alzheimer's disease, so, knowing that many brain and nervous system-targeted medications can provoke insulin resistance and diabetes, I started asking questions about this person's medications.

We called the friend we were discussing for a complete list. Sure enough, in the battery of medications he had been prescribed...was valproic acid, or Depakote. Depakote is well documented to promote the development of metabolic syndrome--a cluster of problems including hypertension, insulin resistance, diabetes, and high cholesterol. Much of the research in this area has focused on women, because polycystic ovary syndrome, a feminine variant of metabolic syndrome, is also correlated with Depakote use. If you're looking for research on the effects of Depakote in men, it's there, it's just a little harder to find.

New research is suggesting that there is a link between diabetes and Alzheimer's disease. Some researchers even call it diabetes of the brain, and there is some evidence to suggest that diabetes medications such as metformin can help delay the progression of Alzheimer's syndrome.

So here we have a guy who has been prescribed a seizure medication, which has likely provoked his problems with diabetes, which is likely worsening his Alzheimer's disease...and what do you know? It seems as though now that he is on galantamine (Reminyl) for his Alzheimer's disease, he's started noticing tremors. I'd bet money on the possibility that the seizure meds are adjusted upward as a result.

So you can see where I'm going. Not only does this keep this poor guy's physicians busy, it pads the pockets of more than one pharmaceutical company, in progressively more expensive chunks.

My friend asked me what I would do? Well, I must qualify that I am not a prescribing medical doctor. I am a registered dietitian who studies the brain and nervous system. But this is where I'd go.

1. Based on the evidence that seizure disorders respond well to omega-3 fatty acids, I'd up those to a DHA equivalent of 1000 mg per day.
2. To help those omega-3's be most effective, I'd teach this person my "S" and "C" rule (avoid, as much as possible, all fats and oils beginning with the letters "S" and "C"...canola being the only exception). I know my friend and his friend eat out quite a bit and it likely is a significant source of these oils.
3. If you reduce the seizure and tremor activity, you reduce the need for seizure medication, and minimizing medications is always very important.
4. I would consider an alternative seizure medication with less potential for disrupting hormone balance. The one that I have seen repeatedly and successfully used in women to achieve this is lamotrigine (Lamictal). Of course, there may be a reason we do not know of that this would not be appropriate, but if this has not been considered it's certainly worth a try.
5. Less Depakote (or potentially no Depakote) potentially also means less insulin resistance, which provides the possibility that the Alzheimer's medication could be reduced. Again, less meds....fewer side effects.
6. Finally, acetyl l-carnitine has been shown to effectively reduce symptoms of diabetes as well as Alzheimer's disease. It also improves cholesterol profiles. And...it has repeatedly and specifically been found to effectively counter the negative side effects of Depakote. I have seen this cited so often recently I can't understand why it is not automatic for any physician prescribing Depakote to simultaneously recommend carnitine.

This trend, of treating one symptom, letting side effects develop, then treating them with other meds that create other side effects, which eventually build vicious cycles of ever-increasing doses of medications...in recent years...has spiraled out of control. The field of nutritional psychiatry is just out of the starting gate. But I'm hooked on its potential. Hopefully in this case, and for others who find this blog, we can help back our friends out of these pharmaceutical corners, save them some money, and improve their overall quality of life.



Luef G, Abraham I, Trinka E, Alge A, Windisch J, Daxenbichler G, Unterberger I, Seppi K, Lechleitner M, Kramer G, Bauer G. Hyperandrogenism, postprandial hyperinsulinism and the risk of PCOS in a cross sectional study of women with epilepsy treated with valproate. Epilepsy Res 2002 Jan;48(1-2):91-102.

Tan H, Orbak Z, Kantarci M, Kocak N, Karaca L. Valproate-induced insulin resistance in prepubertal girls with epilepsy. J Pediatr Endocrinol Metab 2005 Oct;18(10):985-9.

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Want to get someone's attention? Mess with their head

In all the years I've been doing this work, I've noticed people gradually tune out messages about fitness, weight management, and exercise...at least the ones with meaningful, important information. Except when it comes to their brains.

This past weekend, for example, I ran a demo booth at a local Whole Foods store for one of my company's sponsors, Organic Bistro. A gentleman and his son stopped by, and I offered them some samples of salmon cakes. The man pretty much went off on me.

"I'm vegan. I'm 51 years old. I'm a professional athlete. Just look at this body. Look at my legs. Do I look like I need your food? If I didn't know what I was doing would I be in this condition?"

I let him rant, and accommodated, interestingly, his wish that his son get a sample of the food that in his mind was not good enough for him.

After he finished, I said to him, "You clearly take very good care of yourself. I'm curious, though, because I'm a sports nutritionist and even athletes seem to not be getting some really important information about nutrition. Did you know that omega-3 fatty acids have been found to delay and possibly prevent the progression of Alzheimer's disease? And that it is possible but not easy to get those omega-3's in a completely vegan diet?"

The man's posture slumped, his voice got quiet, and he said, "My wife has permission, if I ever go there...to shoot me."

Since he'd dug a hole for himself and everyone in the frozen food aisle had been drawn into this interchange because of its decibel level, he couldn't really ask for more information.

So I pulled him aside and suggested that on his own, in the privacy of his own cable connection, that he Google "omega-3" and "Alzheimer's" and draw his own conclusions.

I'm not sure why it is that we're ok with a few extra pounds, we can justify eating that piece of cake even if we've been diagnosed with diabetes and there is a possibility that poor dietary choices might even lead to amputation...or eating those potato chips even though we want a baby and the evidence suggests that trans fats interfere with fertility...

...but you mention the brain and you've got a whole new, motivated audience.

My guess is, that by the time I'd broken down my demo this athlete had already been online learning about Alzheimer's. And hopefully, by now, has been back to Whole Foods for some of those really tasty wild salmon cakes.

It's the marijuana, stupid

Much of my work is with polycystic ovary syndrome, PCOS, an inflammatory syndrome that is the leading cause of infertility in the United States. Women who have this syndrome are plagued with intense carbohydrate cravings that can make it nearly impossible to follow any kind of healthy diet.

A dietitian with the syndrome, who had a master's degree in nutrition, once told me, "If it's carbohydrate, and it's not nailed down...I eat it."

It happens more often than not, when I work with clients who have PCOS, that they cannot conceive of being in a physiological state where the majority of their thoughts revolve around sugar and where to find more. They might politely listen to what I have to say about how to eat to quell these cravings, but the inevitable question at the end of my pitch for my nutrition plan is, "OK, but what am I going to do when I crave sugar?" They have absolutely no knowledge of a time when cravings did not rule their food choices, and their experience causes them to assume that my program is going to fail their expectations just as every other diet has done.

That's why I work so hard for those clients who are willing to trust me and try my program. It's incredibly rewarding to talk to them a couple of weeks later and hear the surprised delight over not spending hours of time and energy trying to suppress the urge to binge on a chocolate cake.

It seems that one of the reasons women with PCOS have so much trouble with their carbohydrate cravings, is that their endocannabinoid systems are out of balance.

You may know of cannabinoids as the substance in marijuana that causes the munchies. These compounds have been found to be important appetite regulators.

Of course, in Western medicine, when receptor trouble is identified, that means dozens of scientists in drug companies around the world race to find the right chemical to fix the troubled receptor.

Currently, a drug has been developed designed to "improve" the function of cannabinoid receptors. For a lot of obesity scientists, this drug, rimonabant, (Acomplia), was supposed to be the obesity miracle drug. However, Acomplia was tripped up during the FDA approval process, because there were concerns about an increased risk of severe depression being a major side effect. That is what has been tested and observed with Acomplia use.

What is also apparently a concern is that since this drug is somewhat like "anti-marijuana," it has potential for antagonizing many of the neuroprotective properties that marijuana may actually have. In other words, users of Acomplia may find themselves at increased risk of neurodegenerative diseases such as Multiple sclerosis, Alzheimer's disease, Amyotrophic lateral sclerosis (ALS), Parkinson's disease, and Huntington's disease.

So what are women with PCOS--and men whose obesity is also fueled by carbohydrate cravings supposed to do?

If you're a regular reader of this blog, you should know by now that the first answer to any question should always be fish oil. :) Yup, fish oil can help to silence the marijuana munchies.

I included a reference for your perusal, but I have to say, it was a client who taught me about this. We'd spent a couple of hours in our initial assessment, and I gave her my standard omega-3 and diet protocol. She had been embarrassed to tell me in that initial meeting, that every Sunday evening she baked a chocolate cake, which she used to satisfy her voracious carbohydrate appetite. Two weeks into using fish oil, she had thrown out two chocolate cakes, because her appetite for sweets had so radically diminished, she didn't even think about bingeing.

The relationship between carbohydrates and omega-3 balance is so strong, that I know I've titrated the right dose of fish oil with the right amount of other fats when the cravings are gone.

If you've taken fish oil and you have not experienced a drop in carb cravings, chances are you either aren't taking enough of the stuff...or you haven't eliminated enough of the other fats that get in the way of fish oil doing its amazing job.

So don't despair because the FDA kept rimonabant out of the drug supply and out of YOU. Give thanks, and look to the ocean for an even better way of getting the same results.

Pasquali R, Gambineri A, Pagotto U. The impact of obesity on reproduction in women with polycystic ovary syndrome. BJOG. 2006 Oct;113(10):1148-59. Epub 2006 Jul 7.

http://www.springerlink.com/content/41v7536525023722/

Kim AH, Kerchner GA, and Choi DW. Blocking Excitotoxicity. Chapter 1 in CNS Neuroprotection. Marcoux FW and Choi DW, editors. Springer, New York. 2002. Pages 3-36.

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Watanabe S, Doshi M, Hamazaki T. n-3 Polyunsaturated fatty acid (PUFA) deficiency elevates and n-3 PUFA enrichment reduces brain 2-arachidonoylglycerol level in mice. Prostaglandins Leukot Essent Fatty Acids. 2003 Jul;69(1):51-9.

An egg-selent idea for slowing down Alzheimer's

On my infertility (PCOS) blog, I post a weekly item about a food and its health benefits. This week I chose eggs, which have a couple of brain-related nutrients I thought you all, as readers of this blog would enjoy. So I am cross-posting for your benefit.


Aaahhh eggs, the misunderstood member of the nutrition family. Poor guys...when I graduated from college, in the height of the low cholesterol-low fat craze, we were indoctrinated to teach that "egg" was just another word for poison.

My how things have changed!

A couple of months ago I heard Dr. Susan Kleiner (www.goodmooddiet.com) speak at a conference. She shared that not once has there been a research study demonstrating that when you take eggs out of the diet, that this dietary change reduces cholesterol. As well, there has been research demonstrating that adding eggs (plus yolks) to the diet does NOT raise cholesterol. All those yolks I threw down the drain all those years...for nothing.

I figured I'd better find some hard research to back THAT one up, so here's a quick list of interesting titles I found in PubMed:
Dietary cholesterol from eggs increases plasma HDL cholesterol in
overweight men consuming a carbohydrate-restricted diet
Egg yolk improves lipid profile, lipid peroxidation and retinal abnormalities
in a murine model of genetic hypercholesterolemia.
There are many more, but here I just wanted to make my point. Egg yolks are not the ugly stepchild of the protein family anymore.

In fact, there are some great nutrients to be found in eggs.

1. Lutein and xeanthin are two carotenoid compounds that can help maintain visual health. One group of researchers reported that 6 eggs per week can help increase lutein and xeanthin levels in the macula, the part of the eye that degenerates in this country's leading cause of blindness, macular degeneration.

2. Eggs contain choline. This compound is very important for brain function. Choline is the building block for acetylcholine, the neurotransmitter involved in memory, and the one that many Alzheimer's medications seek to increase.

This compound is exceedingly hard to get in the diet. In fact, about the only two places you can find it, are egg yolks, and soy. (Well, also in cooked chicken, beef, veal, and turkey livers, but I didn't think that would have any of you running for your grocery lists so it goes in parentheses.)

If you've got PCOS, you've probably been told to avoid soy. So that leaves egg yolks for getting this very important memory booster.

3. If you hate fish but you need to increase your fish-based omega-3 intake, omega-3 eggs are a very cost-effective option. If you struggle to get enough vegetables in your diet, omelets and frittatas are great ways to get them in. Just be sure you use olive oil when you cook them.

I thought it might be timely to include eggs on this blog, because as food prices rise, they can certainly be much more cost-effective than salmon, as well as other proteins that are now taxing your grocery bill.

Mutungi G, Ratliff J, Puglisi M, Torres-Gonzalez M, Vaishnav U, Leite JO, Quann E, Volek JS, Fernandez ML. Dietary cholesterol from eggs increases plasma HDL cholesterol in overweight men consuming a carbohydrate-restricted diet. J Nutr. 2008 Feb;138(2):272-6.

Fernández-Robredo P, Rodríguez JA, Sádaba LM, Recalde S, García-Layana A.
Egg yolk improves lipid profile, lipid peroxidation and retinal abnormalities in a murine model of genetic hypercholesterolemia. J Nutr Biochem. 2008 Jan;19(1):40-8.

Wenzel AJ, Gerweck C, Barbato D, Nicolosi RJ, Handelman GJ, Curran-Celentano J. A 12-wk egg intervention increases serum zeaxanthin and macular pigment optical density in women. J Nutr. 2006 Oct;136(10):2568-73.

Goodrow EF, Wilson TA, Houde SC, Vishwanathan R, Scollin PA, Handelman G, Nicolosi RJ. Consumption of one egg per day increases serum lutein and zeaxanthin concentrations in older adults without altering serum lipid and lipoprotein cholesterol concentrations. J Nutr. 2006 Oct;136(10):2519-24.

V is for brain Viagra....REALLY?

Since I spent the last post questioning the validity of an herbal supplement, I wanted to balance my blog by sharing another herb with some evidence-based potential.

One of my friends is very into nutrition...and his questions for me challenge me to keep up-to-date and be cutting edge. One day he wrote to ask if I'd ever heard of an herb called "vinpocetine." He'd heard it was like Viagra for the brain, in that it increased brain blood flow and circulation of vital nutrients, while making it easier for the brain to remove toxic waste products.

I rolled my eyes as I read his email, thinking I'd heard it all. But, curious, I went to PubMed. Sure enough, there were 23 pages of titles about vinpocetine and the hopeful actions it seemed to have on the brain and nervous system; the first one was published way back in 1979!

If you happen to be reading this, Michael, I greatly appreciate your voracious curiosity and your generosity in sharing things you learn with me. You get credit for this "find" and I want to thank you for giving me a great opportunity to help a lot of people who may benefit from this information. :)

Vinpocetine, also known as Caviton, is a derivative of a plant in the periwinkle family. In the brain, some of the effects of vinpocetine appear to be:
(1) protecting the brain against ischemic cell damage (the kind of damage that occurs when there is insufficient oxygen). Improved glucose utilization and blood flow in damaged areas has been shown when vinpocetine was administered even a week or two after the ischemic damage occurred;
(2) acting as a vasodilator (as my friend suggested, improves blood flow), which has been shown to be beneficial in treating vascular dementia and stroke;
(3) reducing seizure activity and potentially helping to manage epilepsy;
(4) improving the flexibility of red blood cells, making it easier for them to move through constricted spaces and therefore improving blood flow;
(5) preventing death to neurons that have been overstimulated by excitatory substances such as glutamate;
(6) protecting cells from the damage created by amyloid beta peptides, making it a potential treatment for Alzheimer's disease;
(7) improving the function of norepinephrine, a neurotransmitter important to memory function;
(8) enhancing the neuroprotective activity of other compounds such as adenosine;
(9) improving the uptake of glucose through the blood-brain barrier (glucose is the brain's primary energy source);
(10)acting as an antioxidant, protecting neurons from stress-related damage; and
(11) protecting astrocytes, another type of brain cell that supports the blood-brain barrier, nourishes other brain cells, and repairs brain tissue.

Vinpocetine appears to be particularly effective in the hippocampus, the brain's factual memory center. Learning and memory have actually been shown to improve in individuals who have been given vinpocetine.

Vinpocetine may also promote health outside of the brain and nervous system. It has been shown to lessen menopausal symptoms, prevent the development of gastric lesions created on exposure to substances such as alcohol, and help with urinary incontinence. It reduces gallbladder motility and, potentially, gallstone formation. It has been used to treat tumoral calcinosis, (calcium-based masses). And it shows potential in controlling pain.

One small nutritional note: vinpocetine appears to be better absorbed when taken after a meal than it does when taken on an empty stomach.

Many of the articles about vinpocetine are in Russian, Chinese, and Hungarian. On the chance that anyone reading this may wish to read some of the references, I only cited studies written in English. But if you go to Pub Med (http://www.ncbi.nlm.nih.gov/sites/entrez)and key in "vinpocetine", you can see for yourself just how much this herb has been studied.

I will note, there are also studies refuting the effectiveness of vinpocetine, but the results seem to vary depending on study design. My guess is that, just like with medications, different people will respond to different treatments in a variety of ways. The one thing I DID like about what I found, was that there were no studies suggesting any dangers to using vinpocetine. If it can't hurt...and it might help...why not try it?

Abdel Salam OM. Vinpocetine and piracetam exert antinociceptive effect in visceral pain model in mice. Pharmacol Rep. 2006 Sep-Oct;58(5):680-91.

Araki T, Kogure K, Nishioka K. Comparative neuroprotective effects of pentobarbital, vinpocetine, flunarizine and ifenprodil on ischemic neuronal damage in the gerbil hippocampus. Res Exp Med (Berl). 1990;190(1):19-23.

Bereczki D, Fekete I. Vinpocetine for acute ischaemic stroke. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD000480.

Bönöczk P, Gulyás B, Adam-Vizi V, Nemes A, Kárpáti E, Kiss B, Kapás M, Szántay C, Koncz I, Zelles T, Vas A. Role of sodium channel inhibition in neuroprotection: effect of vinpocetine. Brain Res Bull. 2000 Oct;53(3):245-54.

Bönöczk P, Panczel G, Nagy Z. Vinpocetine increases cerebral blood flow and oxygenation in stroke patients: a near infrared spectroscopy and transcranial Doppler study. Eur J Ultrasound. 2002 Jun;15(1-2):85-91.

Erdö SL, Cai NS, Wolff JR, Kiss B. Vinpocetin protects against excitotoxic cell death in primary cultures of rat cerebral cortex. Eur J Pharmacol. 1990 Oct 23;187(3):551-3.

Feigin VL, Doronin BM, Popova TF, Gribatcheva EV, Tchervov DV. Vinpocetine treatment in acute ischaemic stroke: a pilot single-blind randomized clinical trial. Eur J Neurol. 2001 Jan;8(1):81-5.

Gaál L, Molnár P. Effect of vinpocetine on noradrenergic neurons in rat locus coeruleus. Eur J Pharmacol. 1990 Oct 23;187(3):537-9.

Gabryel B, Adamek M, Pudełko A, Małecki A, Trzeciak HI. Piracetam and vinpocetine exert cytoprotective activity and prevent apoptosis of astrocytes in vitro in hypoxia and reoxygenation. Neurotoxicology. 2002 May;23(1):19-31.

Hadjiev D. Asymptomatic ischemic cerebrovascular disorders and neuroprotection with vinpocetine.Ideggyogy Sz. 2003 May 20;56(5-6):166-72.

Hayakawa M. Comparative efficacy of vinpocetine, pentoxifylline and nicergoline on red blood cell deformability. Arzneimittelforschung. 1992 Feb;42(2):108-10.

Hayakawa M. Effect of vinpocetine on red blood cell deformability in vivo measured by a new centrifugation method. Arzneimittelforschung. 1992 Mar;42(3):281-3.

Hayakawa M. Effect of vinpocetine on red blood cell deformability in stroke patients. Arzneimittelforschung. 1992 Apr;42(4):425-7.

Hindmarch I, Fuchs HH, Erzigkeit H. Efficacy and tolerance of vinpocetine in ambulant patients suffering from mild to moderate organic psychosyndromes. Int Clin Psychopharmacol. 1991 Spring;6(1):31-43.

Horvath B, Marton Z, Halmosi R, Alexy T, Szapary L, Vekasi J, Biro Z, Habon T, Kesmarky G, Toth K. In vitro antioxidant properties of pentoxifylline, piracetam, and vinpocetine. Clin Neuropharmacol. 2002 Jan-Feb;25(1):37-42.

Ishihara K, Katsuki H, Sugimura M, Satoh M. Idebenone and vinpocetine augment long-term potentiation in hippocampal slices in the guinea pig. Neuropharmacology. 1989 Jun;28(6):569-73.

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Kemény V, Molnár S, Andrejkovics M, Makai A, Csiba L. Acute and chronic effects of vinpocetine on cerebral hemodynamics and neuropsychological performance in multi-infarct patients. J Clin Pharmacol. 2005 Sep;45(9):1048-54.

Kidd PM. A review of nutrients and botanicals in the integrative management of cognitive dysfunction. Altern Med Rev. 1999 Jun;4(3):144-61.

Kiss E. Adjuvant effect of cavinton in the treatment of climacteric symptoms. Ther Hung. 1990;38(4):170-3.

Krieglstein J. Vinpocetine increases the neuroprotective effect of adenosine in vitro. Eur J Pharmacol. 1991 Nov 19;205(1):7-10.

Lakics V, Sebestyén MG, Erdö SL. Vinpocetine is a highly potent neuroprotectant against veratridine-induced cell death in primary cultures of rat cerebral cortex. Neurosci Lett. 1995 Feb 9;185(2):127-30.

Lakics V, Sebestyén MG, Erdö SL. Cerebral effects of a single dose of intravenous vinpocetine in chronic stroke patients: a PET study.Szakáll S, Boros I, Balkay L, Emri M, Fekete I, Kerényi L, Lehel S, Márián T, Molnár T, Varga J, Galuska L, Trón L, Bereczki D, Csiba L, Gulyás B. J Neuroimaging. 1998 Oct;8(4):197-204.

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Lohmann A, Dingler E, Sommer W, Schaffler K, Wober W, Schmidt W. Bioavailability of vinpocetine and interference of the time of application with food intake. Arzneimittelforschung. 1992 Jul;42(7):914-7.

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Molnár P, Erdö SL. Vinpocetine is as potent as phenytoin to block voltage-gated Na+ channels in rat cortical neurons. Eur J Pharmacol. 1995 Feb 6;273(3):303-6.

Nosálová V, Machová J, Babulová A. Protective action of vinpocetine against experimentally induced gastric damage in rats. Arzneimittelforschung. 1993 Sep;43(9):981-5.

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Rischke R, Krieglstein J. Protective effect of vinpocetine against brain damage caused by ischemia. Jpn J Pharmacol. 1991 Jul;56(3):349-56.

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Sauer D, Rischke R, Beck T, Rossberg C, Mennel HD, Bielenberg GW, Krieglstein J. Vinpocetine prevents ischemic cell damage in rat hippocampus. Life Sci. 1988;43(21):1733-9.

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Sitges M, Chiu LM, Guarneros A, Nekrassov V. Effects of carbamazepine, phenytoin, lamotrigine, oxcarbazepine, topiramate and vinpocetine on Na+ channel-mediated release of [3H]glutamate in hippocampal nerve endings. Neuropharmacology. 2007 Feb;52(2):598-605. Epub 2006 Oct 30.

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Tohgi H, Sasaki K, Chiba K, Nozaki Y. Effect of vinpocetine on oxygen release of hemoglobin and erythrocyte organic polyphosphate concentrations in patients with vascular dementia of the Binswanger type. Arzneimittelforschung. 1990 Jun;40(6):640-3.

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