Transcranial Electromagnetic Treatment in Alzheimer’s Disease: Cognitive Enhancement and Associated Changes in Cerebrospinal Fluid, Blood, and Brain Imaging 

Posted on September 26, 2019 | Comments Off on Transcranial Electromagnetic Treatment in Alzheimer’s Disease: Cognitive Enhancement and Associated Changes in Cerebrospinal Fluid, Blood, and Brain Imaging 
A) A MemorEMTM head device being worn by a subject. B) Position of the eight electromagnetic emitters embedded between the device’s two-layered head cap. Emitters collectively provide global forebrain TEMT via rapid sequential emitter activation.

This is from the cited journal article. I hope this is considered fair use rather than copyright infringement.

This is the most creative therapeutic approach to Alzheimer’s Disease I’ve seen in a while. It may even be preventative. I have no idea whether it will pan out in the long run. I’m always skeptical.

Click for a Scientific American article that discusses a different experimental protocol and probably different device.

Abstract

Background: Small aggregates (oligomers) of the toxic proteins amyloid-β (Aβ) and phospho-tau (p-tau) are essential contributors to Alzheimer’s disease (AD). In mouse models for AD or human AD brain extracts, Transcranial Electromagnetic Treatment (TEMT) disaggregates both Aβ and p-tau oligomers, and induces brain mitochondrial enhancement. These apparent “disease-modifying” actions of TEMT both prevent and reverse memory impairment in AD transgenic mice.

Objective: To evaluate the safety and initial clinical efficacy of TEMT against AD, a comprehensive open-label clinical trial was performed.

Methods: Eight mild/moderate AD patients were treated with TEMT in-home by their caregivers for 2 months utilizing a unique head device. TEMT was given for two 1-hour periods each day, with subjects primarily evaluated at baseline, end-of-treatment, and 2 weeks following treatment completion.

Results: No deleterious behavioral effects, discomfort, or physiologic changes resulted from 2 months of TEMT, as well as no evidence of tumor or microhemorrhage induction. TEMT induced clinically important and statistically significant improvements in ADAS-cog, as well as in the Rey AVLT. TEMT also produced increases in cerebrospinal fluid (CSF) levels of soluble Aβ1-40 and Aβ1-42, cognition-related changes in CSF oligomeric Aβ, a decreased CSF p-tau/Aβ1-42 ratio, and reduced levels of oligomeric Aβ in plasma. Pre- versus post-treatment FDG-PET brain scans revealed stable cerebral glucose utilization, with several subjects exhibiting enhanced glucose utilization. Evaluation of diffusion tensor imaging (fractional anisotropy) scans in individual subjects provided support for TEMT-induced increases in functional connectivity within the cognitively-important cingulate cortex/cingulum.

Conclusion: TEMT administration to AD subjects appears to be safe, while providing cognitive enhancement, changes to CSF/blood AD markers, and evidence of stable/enhanced brain connectivity.

Source: A Clinical Trial of Transcranial Electromagnetic Treatment in Alzheimer’s Disease: Cognitive Enhancement and Associated Changes in Cerebrospinal Fluid, Blood, and Brain Imaging – IOS Press

Steve Parker, M.D.

PS: I notice that several of the study authors are based in my area of operations, south-central Arizona.

PPS: The Mediterranean diet for years has been linked to lower risk of dementia.

Steve Parker MD, Advanced Mediterranean Diet

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Posted in Alzheimer Disease, Dementia

High-Dose Vitamin D Supplementation May Be Worse or No Better Than Low-Dose

Posted on September 25, 2019 | Comments Off on High-Dose Vitamin D Supplementation May Be Worse or No Better Than Low-Dose

Lately I’m seeing more patients taking high-dose vitamin D supplements (usually D3, aka cholecalciferol) rather than traditional 400–800 IU/day.

From a recent study:

This randomized trial compares the effects of 400 vs 4000 vs 10 000 IU of vitamin D on total volumetric bone mineral density and bone strength of the radius and tibia.

Conclusion:

Among healthy adults, treatment with vitamin D for 3 years at a dose of 4000 IU per day or 10 000 IU per day, compared with 400 IU per day, resulted in statistically significant lower radial BMD; tibial BMD was significantly lower only with the 10 000 IU per day dose. There were no significant differences in bone strength at either the radius or tibia. These findings do not support a benefit of high-dose vitamin D supplementation for bone health; further research would be needed to determine whether it is harmful.

Source: Effect of High-Dose Vitamin D Supplementation on Volumetric Bone Density and Bone Strength: A Randomized Clinical Trial | Osteoporosis | JAMA | JAMA Network

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com

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Posted in Osteoporosis, Supplements

Animal Versus Plant Protein: Which Is Healthier?

Posted on September 21, 2019 | Comments Off on Animal Versus Plant Protein: Which Is Healthier?

Filet mignon and sautéed asparagus

“In this large prospective study, higher plant protein intake was associated with lower total and CVD-related mortality. Although animal protein intake was not associated with mortality outcomes, replacement of red meat protein or processed meat protein with plant protein was associated with lower total, cancer-related, and CVD-related mortality.”

Source: Association of Animal and Plant Protein Intake With All-Cause and Cause-Specific Mortality | Cardiology | JAMA Internal Medicine | JAMA Network

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

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Posted in Cancer, Coronary Heart Disease, Heart Disease, High Blood Pressure, Stroke

Soft Drinks Kill

Posted on September 19, 2019 | Comments Off on Soft Drinks Kill

Green tea is not linked to premature death

The study at hand involved Europeans. It’s the first time I’ve seen artificially-sweetened soft drinks linked to premature death.

From JAMA Network:

This study found that consumption of total, sugar-sweetened, and artificially sweetened soft drinks was positively associated with all-cause deaths in this large European cohort; the results are supportive of public health campaigns aimed at limiting the consumption of soft drinks.

Source: Association Between Soft Drink Consumption and Mortality in 10 European Countries | Cardiology | JAMA Internal Medicine | JAMA Network

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

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Posted in Longevity, Sugar Substitutes

Does Calcium  Intake Affect Postmenopausal Osteoporosis or Osteopenia?

Posted on September 18, 2019 | 1 comment

Waste of money and effort?

Many physicians worry that inadequate calcium consumption causes or contributes to thin, brittle, easily breakable bones in postmenopausal women. A recent study suggests that calcium intake doesn’t matter.

Abstract

CONTEXT:

Calcium intakes are commonly lower than the recommended levels, and increasing calcium intake is often recommended for bone health.

OBJECTIVE:To determine the relationship between dietary calcium intake and rate of bone loss in older postmenopausal women.

PARTICIPANTS:

Analysis of observational data collected from a randomized controlled trial. Participants were osteopenic (hip T-scores between -1.0 and -2.5) women, aged >65 years, not receiving therapy for osteoporosis nor taking calcium supplements. Women from the total cohort (n = 1994) contributed data to the analysis of calcium intake and bone mineral density (BMD) at baseline, and women from the placebo group (n = 698) contributed data to the analysis of calcium intake and change in BMD. BMD and bone mineral content (BMC) of the spine, total hip, femoral neck, and total body were measured three times over 6 years.

RESULTS:

Mean calcium intake was 886 mg/day. Baseline BMDs were not related to quintile of calcium intake at any site, before or after adjustment for baseline age, height, weight, physical activity, alcohol intake, smoking status, and past hormone replacement use. There was no relationship between bone loss and quintile of calcium intake at any site, with or without adjustment for covariables. Total body bone balance (i.e., change in BMC) was unrelated to an individuals’ calcium intake (P = 0.99).

CONCLUSIONS:

Postmenopausal bone loss is unrelated to dietary calcium intake. This suggests that strategies to increase calcium intake are unlikely to impact the prevalence of and morbidity from postmenopausal osteoporosis.

Source: Dietary Calcium Intake and Bone Loss Over 6 Years in Osteopenic Postmenopausal Women. – PubMed – NCBI

Steve Parker, M.D.

PS: Elderly men get osteoporosis, too. But when the Emergency Department calls me to admit an older patient with a hip fracture, it’s a woman 9 out of 10 times.

Steve Parker MD, Advanced Mediterranean Diet

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Posted in Osteoporosis

QOTD: H.L. Mencken on Practical Politics

Posted on September 11, 2019 | Comments Off on QOTD: H.L. Mencken on Practical Politics

The whole aim of practical politics is to keep the populace alarmed (and hence clamorous to be led to safety) by menacing it with an endless series of hobgoblins, all of them imaginary.

—H.L. Mencken (born in 1880)

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Substitution of Tea or Coffee for Sugar-Sweetened Beverages Linked to Lower Type 2 Diabetes Incidence in Europe

Posted on September 10, 2019 | Comments Off on Substitution of Tea or Coffee for Sugar-Sweetened Beverages Linked to Lower Type 2 Diabetes Incidence in Europe

Green tea

Sugar-sweetened beverages (SSBs) increase the risk of developing type 2 diabetes. If you want to avoid T2 diabetes, what should you substitute? The study at hand looked at milk, juice, coffee, and tea. Why not water?

From The Journal of Nutrition:

These findings indicate a potential benefit of substituting coffee or tea for SSBs for the primary prevention of T2D and may help formulate public health recommendations on beverage consumption in different populations.

Source: Estimated Substitution of Tea or Coffee for Sugar-Sweetened Beverages Was Associated with Lower Type 2 Diabetes Incidence in Case–Cohort Analysis across 8 European Countries in the EPIC-InterAct Study | The Journal of Nutrition | Oxford Academic

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Two diets in one book, including the Ketogenic Mediterranean Diet

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Posted in Diabetes, Sugar Substitutes

If Gut Bacteria Cause Alzheimer’s Dementia, What If You Alter Those Bacteria?

Posted on September 8, 2019 | 3 comments

The short answer? We don’t know the answer to either of those questions.

Low-carb salad

The gut bacteria (aka microbiome) seem to be able to decrease or increase inflammation that could cause or exacerbate Alzheimer’s dementia. The  microbiome’s effect on inflammation depends on the species of bacteria present, and the amount of those bacteria. At least one study found that Alzheimer’s patients have a greater abundance of the pro-inflammatory species and less of the anti-inflammatory species, compared to other folks.

Researchers with Wake Forest School of Medicine tried to find answers to the questions in the title of this post. (Click for full text.) They studied 17 experimental subjects, average age 64, who had mild cognitive impairment (11) or “cogni/subjective memory complaints” (6). God bless them for submitting to three spinal taps apiece. The experimental diets were 1) Mediterranean-Ketogenic (under 20 g carb/day), or 2) Low-fat American Heart Association diet (under 40 g fat/day). Participants were on each diet for six weeks.

The investigators didn’t find anything useful for those of us trying today to avoid Alzheimer’s or prevent the progression of mild cognitive impairment to dementia. Their bottom line is, “The data suggest that specific gut microbial signatures may depict [characterize] the mild cognitive impairment and that the modified Mediterranean-ketogenic diet can modulate the gut microbiome and metabolites in association with improved Alzheimer’s disease biomarkers in cerebrospinal fluid.”

So we won’t know for several more years, if ever, whether intentional modification of diet will “improve” our gut microbiomes, leading to lower risk of dementia.

What we have known for many year, however, is that the traditional Mediterranean diet is linked to lower risk of Alzhiemer’s dementia.

For more details, see Science Daily:

In a small pilot study, the researchers identified several distinct gut microbiome signatures — the chemicals produced by bacteria — in study participants with mild cognitive impairment (MCI) but not in their counterparts with normal cognition, and found that these bacterial signatures correlated with higher levels of markers of Alzheimer’s disease in the cerebrospinal fluid of the participants with MCI.

Through cross-group dietary intervention, the study also showed that a modified Mediterranean-ketogenic diet produced changes in the gut microbiome and its metabolites that correlated with reduced levels of Alzheimer’s markers in the members of both study groups.

Source: Diet’s effect on gut bacteria could play role in reducing Alzheimer’s risk — ScienceDaily

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Two diets in one book, including the Ketogenic Mediterranean Diet

Click the pic to purchase the world’s first practical ketogenic Mediterranean diet at Amazon.com

 

3 Comments

Posted in Alzheimer Disease, Dementia, Low-Carb Eating, Low-Carb Mediterranean Diet

Mediterranean Diet May Prevent Multiple Sclerosis

Posted on September 7, 2019 | Comments Off on Mediterranean Diet May Prevent Multiple Sclerosis

MRI scan of brain, commonly done to evaluate for MS and demyelination

Multiple sclerosis is a disease of unknown cause characterized by demyelination (loss of the protective coating around nerves) in the brain.

From The Journal of Nutrition:

A Mediterranean diet, including unprocessed red meat, was associated with reduced risk of [first clinical diagnosis of brain demyelination] in this Australian adult population. The addition of unprocessed red meat to a Mediterranean diet may be beneficial for those at high risk of [multiple sclerosis].

Source: Higher Mediterranean Diet Score, Including Unprocessed Red Meat, Is Associated with Reduced Risk of Central Nervous System Demyelination in a Case-Control Study of Australian Adults | The Journal of Nutrition | Oxford Academic

Steve Parker MD, Advanced Mediterranean Diet

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Association of Intensive vs Standard Blood Pressure Control With Brain Small Vessel Ischemic Disease

Posted on September 5, 2019 | Comments Off on Association of Intensive vs Standard Blood Pressure Control With Brain Small Vessel Ischemic Disease

Not good enough

Aiming for systolic blood pressure of 120 or less (instead of 140) may reduce the risk of age-related brain impairment. A recent study suggests the mechanism is better brain blood flow.

The 2017 guidelines from the American College of Cardiology recommend a BP treatment goal of under 130/80.

Ischemia means poor or no blood flow.

Small vessel ischemic disease (SVID in the brain) is something I see so often on CT scans of 70-year-olds that I usually ignore it. Mind you, I’m a hospitalist and usually looking for acute major strokes, brain tumors, and bleeding on CT scans. SVID is a chronic disease and it’s often difficult to say how long a specific lesion has been present and whether it’s causing symptoms. Ischemia in the brain is linked to impaired cognitive functioning and dementia. On the other hand, some brain ischemic lesions don’t seem to cause any detectable impairment.

From JAMA Network:

Question:  Is intensive blood pressure treatment associated with less progression of small vessel ischemic disease, as reflected by cerebral white matter lesion volume?

Findings:  In this substudy of a randomized clinical trial of 449 hypertensive patients with longitudinal brain magnetic resonance imaging, intensive blood pressure management to a target of less than 120 mm Hg, vs less than 140 mm Hg, was associated with a smaller increase in white matter lesion volume (0.92 cm3 vs 1.45 cm3).

Meaning:  More intensive blood pressure management was associated with less progression of cerebral small vessel ischemic disease, although the difference was small.

Source: Association of Intensive vs Standard Blood Pressure Control With Cerebral White Matter Lesions | Dementia and Cognitive Impairment | JAMA | JAMA Network

Steve Parker, M.D.

PS: The Mediterranean diet also reduces dementia and cognitive impairment.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com

 

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Posted in Dementia, High Blood Pressure