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Published on Leave a comment on Why Do Some Older Adults Have Youthful Brains?

The beginning of a new year is a time to think about the future, and perhaps think about healthy lifestyles and how to age well. One important issue to think about is: why do some older people have "young" minds while others do not? Can anything be done to improve our odds later in life of being a "superager" and having a youthful, sharp, clear mind?

Unfortunately, as humans age, memory and many other cognitive functions often decline. “Normal” performance on various cognitive tests may be substantially lower than that of a younger adult, but... there is substantial variation in the degree of cognitive decline with age. Some older adults—referred to by some as “superagers”—continue to perform mentally at a level similar to middle-aged adults and sometimes even young adults.

Earlier posts have examined some of the things that help people age well and keep their brains more "youthful" - from diet (here, here, and here), to daily coffee consumption, vitamin D levels (here and here), regular physical activity and exercise (here, here, and here), not living in polluted areas (here and here), civic engagement, higher education, learning new skills, doing arts or crafts, and using a computer (here). Also frequently mentioned are social activities, intellectual stimulation, and genetics.

One recent study (discussed below) found that doing something hard and really challenging (that means forget pleasant puzzles), something that tires you out (whether physically or mentally) is what is good for the brain. So go out and learn a new language or musical instrument, sign up for a course, or anything else that is really challenging - whether physical or mental. Excerpts from a piece written by Lisa F. Barrett, a professor of psychology at Northeastern University, from the NY Times:

How to Become a ‘Superager’

Think about the people in your life who are 65 or older. Some of them are experiencing the usual mental difficulties of old age, like forgetfulness or a dwindling attention span. Yet others somehow manage to remain mentally sharp....Why do some older people remain mentally nimble while others decline? “Superagers” (a term coined by the neurologist Marsel Mesulam) are those whose memory and attention isn’t merely above average for their age, but is actually on par with healthy, active 25-year-olds. My colleagues and I at Massachusetts General Hospital recently studied superagers to understand what made them tick.

Our lab used functional magnetic resonance imaging to scan and compare the brains of 17 superagers with those of other people of similar age. We succeeded in identifying a set of brain regions that distinguished the two groups. These regions were thinner for regular agers, a result of age-related atrophy, but in superagers they were indistinguishable from those of young adults, seemingly untouched by the ravages of time...... The thicker these regions of cortex are, the better a person’s performance on tests of memory and attention, such as memorizing a list of nouns and recalling it 20 minutes later.

Of course, the big question is: How do you become a superager? Which activities, if any, will increase your chances of remaining mentally sharp into old age? We’re still studying this question, but our best answer at the moment is: work hard at something. Many labs have observed that these critical brain regions increase in activity when people perform difficult tasks, whether the effort is physical or mental. You can therefore help keep these regions thick and healthy through vigorous exercise and bouts of strenuous mental effort. My father-in-law, for example, swims every day and plays tournament bridge.

The road to superaging is difficult, though, because these brain regions have another intriguing property: When they increase in activity, you tend to feel pretty bad — tired, stymied, frustrated. Think about the last time you grappled with a math problem or pushed yourself to your physical limits. Hard work makes you feel bad in the moment. The Marine Corps has a motto that embodies this principle: “Pain is weakness leaving the body.” That is, the discomfort of exertion means you’re building muscle and discipline. Superagers are like Marines: They excel at pushing past the temporary unpleasantness of intense effort. Studies suggest that the result is a more youthful brain that helps maintain a sharper memory and a greater ability to pay attention.

This means that pleasant puzzles like Sudoku are not enough to provide the benefits of superaging. Neither are the popular diversions of various “brain game” websites. You must expend enough effort that you feel some “yuck.” Do it till it hurts, and then a bit more.

In the United States, we are obsessed with happiness. But as people get older, research shows, they cultivate happiness by avoiding unpleasant situations. This is sometimes a good idea, as when you avoid a rude neighbor. But if people consistently sidestep the discomfort of mental effort or physical exertion, this restraint can be detrimental to the brain. All brain tissue gets thinner from disuse. If you don’t use it, you lose it. So, make a New Year’s resolution to take up a challenging activity. Learn a foreign language. Take an online college course. Master a musical instrument. Work that brain. Make it a year to remember. [Original study]

Published on Leave a comment on A Medical Device Can Sniff Out Multiple Diseases?

 Image result for breathing mouth What if you could detect cancer by a gadget that can sniff for cancer or some other disease? The theory that disease is detectable from exhaled breath dates back to about 400 BC when the Greek physician Hippocrates used to smell his patients' breath to find out what ailed them. More recently a number of individual diseases, such as diabetes, have been detected with "breath analysis".

But Israeli scientist Hossam Haick and others wanted to invent a medical diagnostic tool (an "electronic nose") that could detect multiple diseases, including cancer, by "sniffing" a patient’s exhaled breath. They recently published a study suggesting that such a device that they developed can work for 17 diseases (including 8 types of cancer, Crohn's disease, ulcerative colitis, irritable bowel syndrome, Parkinson's disease, multiple sclerosis, pre-eclampsia in pregnant women, and chronic kidney failure). The results showed that each of these diseases has its own unique "breathprint", and which overall could be detected with 86% accuracy using the device.

The study used breath samples collected from 1,404 people from 2011 to 2014 in 5 countries (Israel, the United States, Latvia, China, and France). The test subjects were either known to be healthy or to be suffering from one of the 17 diseases. Please note that this diagnostic tool is currently being further researched and developed. It is not available yet.

From Science Daily: Nanoarray sniffs out and distinguishes multiple diseases

Before modern medical lab techniques became available, doctors diagnosed some diseases by smelling a patient's breath. Scientists have been working for years to develop analytical instruments that can mimic this sniff-and-diagnose ability. Now, researchers report in the journal ACS Nano that they have identified a unique "breathprint" for each disease. Using this information, they have designed a device that screens breath samples to classify and diagnose several types of diseases.

Exhaled breath contains nitrogen, carbon dioxide and oxygen, as well as a small amount of more than 100 other volatile chemical components. The relative amounts of these substances vary depending on the state of a person's health. As far back as around 400 B.C., Hippocrates told his students to "smell your patients' breath" to search for clues of diseases such as diabetes (which creates a sweet smell). In more recent times, several teams of scientists have developed experimental breath analyzers, but most of these instruments focus on a single type of disease, such as cancer. In their own work, Hossam Haick and a team of collaborators in 14 clinical departments worldwide wanted to create a breathalyzer that could distinguish among multiple diseases.

The researchers developed an array of nanoscale sensors to detect the individual components in thousands of breath samples from patients who were either healthy or had one of 17 different diseases, such as kidney cancer or Parkinson's disease. By analyzing the results with artificial intelligence techniques, the team could use the array to classify and diagnose the conditions. The team used mass spectrometry to identify the breath components associated with the diseases. They found that each disease produces a unique volatile chemical breathprint, based on differing amounts of 13 components. They also showed that the presence of one disease would not prevent the detection of others -- a prerequisite for developing a practical device to screen and diagnose various diseases in a noninvasive, inexpensive and portable manner.

Published on Leave a comment on Focus On Healthy Lifestyle, Not Just On Tests And Screenings

The wonderful blog posts of Dr. John Mandrola (physician, blogger, and columnist at Medscape) are always thoughtful, and this latest points out things a number of studies have pointed out for a while. Which is to stop obsessing or focusing on "preventive tests" and screenings and numbers, and instead focus on a healthy lifestyle - which means getting regular exercise or physical activity, don't smoke cigarettes, maintaining a healthy weight, and eating a healthy diet with lots of fruits, vegetables, nuts, seeds, whole grains, and legumes (think Mediterranean-style diet).

Don't want overdiagnosis and overtreatment (here, here, here, and here). Excerpts from Dr. John M:

I am changing…

The main thing that has changed about me is my views as a doctor, especially when it comes to dealing with people who complain of nothing. Medicine is most pure when we treat people with illness. The infirmed come to us with a problem and we use our intelligence, experience and procedural skills to help them. It’s immensely gratifying. The joy of helping people still negates the stifling burden of administrative nonsense. I’ll do your damn corporate safety modules one more year because helping sick people get well feels so good.

But when people complain of nothing, our first job is to do no harm. I know prevention of disease is better than treating it, but the process of prevention gets dicey. When we prescribe things (screening tests, statins, aspirin, diabetes drugs etc) to people who complain of nothing, we should have the highest evidence these therapies deliver benefit. Too often, we cite eminence rather than evidence.

I’ve come to believe the medical profession is too paternalistic, too arrogant. I fear the medicalization of the human condition. These days, I order fewer tests. Medical tests put people into the “system,” on the metaphorical train of healthcare. This train accelerates quickly, and it’s often hard to get off. Even a simple echo scares me. I could tell you stories.

More often than not, I tell patients to stop checking their “numbers.” If they insist on health numbers, I favor three–the scale, the belt size and a Timex to measure walking speed.

A 2002 article from Dr. David Sackett (a pioneer of evidence-based medicine) perfectly captures my views on preventive medicine. It’s called The Arrogance of Preventive Medicine. It’s worth a look, now more than ever.

Published on Leave a comment on Loss of Smell And Alzheimer’s Disease

Recently some studies have found that a diminished sense of smell occurs in persons with mild cognitive impairment and Alzheimer's disease. Doctors have long observed that patients with Alzheimer's frequently complain that food doesn't taste good anymore (because they can't smell what they are eating). This is because odor signals from the nose are processed in areas of the brain that are among the first to be affected by Alzheimer's disease. It is thought that as dementia starts and progresses, the parts of the brain that distinguish odors start to deteriorate.

This is why various odor tests have been devised. One such odor test (used in the following study) is called "Sniffin Sticks", which tests for 16 odors such as orange, peppermint, leather, banana, garlic, rose, fish, and coffee. However, note that other degenerative brain diseases (including Parkinson's) can also affect odor detection, and the ability to smell can be diminished by smoking, certain head injuries, and even normal aging. From Medical Xpress:

Study confirms 'sniff test' may be useful in diagnosing early Alzheimer's disease

Tests that measure the sense of smell may soon become common in neurologists' offices. Scientists have been finding increasing evidence that the sense of smell declines sharply in the early stages of Alzheimer's, and now a new study from the Perelman School of Medicine at the University of Pennsylvania published today in the Journal of Alzheimer's Disease confirms that administering a simple "sniff test" can enhance the accuracy of diagnosing this dreaded disease. The sniff test also appears to be useful for diagnosing a pre-dementia condition called mild cognitive impairment (MCI), which often progresses to Alzheimer's dementia within a few years.

Roalf and his colleagues used a simple, commercially available test known as the Sniffin' Sticks Odor Identification Test, in which subjects must try to identify 16 different odors. They administered the sniff test, and a standard cognitive test (the Montreal Cognitive Assessment), to 728 elderly people. The subjects had already been evaluated by doctors at Penn with an array of neurological methods, and according to expert consensus had been placed in one of three categories: "healthy older adult," "mild cognitive impairment," or "Alzheimer's dementia." Roalf and his team used the results from the cognitive test alone, or combined with the sniff test, to see how well they identified subjects in each category.

As researchers report, the sniff test added significantly to diagnostic accuracy when combined with the cognitive test. For example, the cognitive test alone correctly classified only 75 percent of people with MCI, but that figure rose to 87 percent when the sniff test results were added. Combining the two tests also enabled more accurate identification of healthy older adults and those with Alzheimer's dementia. The combination even boosted accuracy in assigning people to milder or more advanced categories of MCI.

Prompted by prior studies that have linked a weakening sense of smell to Alzheimer's, doctors in a few larger dementia clinics already have begun to use smell tests in their assessments of elderly patients. Part of the reason the practice has not yet become common is that the tests that seem most useful take too long to administer. 

Published on Leave a comment on Heart Attacks Run In The Family? Healthy Lifestyle Can Really Reduce Risk

 Image result for human heart in human body wikipedia Heart attacks run in the family? Does this mean you are doomed to also have a heart attack? Well, the good news from a large study is that a healthy lifestyle (with at least 3 of these 4 behaviors: not currently smoking, not being obese, regular physical activity at least once per week, and eating a good diet)  lowers the risk of a heart attack by nearly 50% even in those with a high genetic risk for heart attacks. (This is compared to those with an unhealthy lifestyle, which is none or only one healthy behavior.)  In this study a healthy diet was one with lots of fruits, nuts, vegetables, whole grains, fish, and dairy products, and a reduced amount of refined grains, processed meats, red meat, sugar-sweetened beverages, and trans fats.

The researchers also reversed the question and asked: "If you happen to inherit good genes, can a bad lifestyle offset that? We actually found yes." The risk of heart attack is also reduced nearly 50% in those people with good genes and a good lifestyle. BOTTOM LINE: Healthy lifestyle counts, no matter whether heart disease and heart attacks run in the family or not. There is an interaction between the two, From Science Daily:

Following a healthy lifestyle can greatly reduce genetic heart attack risk

It is well known that following a healthy lifestyle -- not smoking, avoiding excess weight and getting regular exercise -- can reduce the risk of heart disease. But what about people who have inherited gene variants known to increase risk? A study led by Massachusetts General Hospital (MGH) investigators has found that, even among those at high genetic risk, following a healthy lifestyle can cut in half the probability of a heart attack or similar event. 

"The basic message of our study is that DNA is not destiny," says Sekar Kathiresan, MD...."Many individuals -- both physicians and members of the general public -- have looked on genetic risk as unavoidable, but for heart attack that does not appear to be the case."  

In order to investigate whether a healthy lifestyle can mitigate genetic risk, the multi-institutional research team analyzed genetic and clinical data from more than 55,000 participants in four large-scale studies. Three of these studies....followed participants for up to 20 years. Each participant in the current analysis was assigned a genetic risk score....The investigators used four AHA-defined lifestyle factors -- no current smoking; lack of obesity (defined as a body mass index less than 30); physical exercise at least once a week; and a healthy dietary pattern -- to determine a lifestyle score, whether participants had a favorable (three or four healthy factors), intermediate (two factors) or unfavorable (one or no healthy factors) lifestyle.

Across all three prospective studies, a higher genetic risk score significantly increased the incidence of coronary events -- as much as 90 percent in those at highest risk. While known risk factors such as a family history and elevated LDL cholesterol were also associated with an elevated genetic risk score, genetic risk was the most powerful contributor to cardiac risk. Similarly, each healthy lifestyle factor reduced risk, and the unfavorable lifestyle group also had higher levels of hypertension, diabetes and other known risk factors upon entering the studies.

Within each genetic risk category, the presence of lifestyle factors significantly altered the risk of coronary events to such an extent that following a favorable lifestyle could reduce the incidence of coronary events by 50 percent in those with the highest genetic risk scores. Among participants in the BioImage study, both genetic and lifestyle factors were independently associated with levels of calcium-containing plaque in the coronary arteries, and healthy lifestyle factors were associated with less extensive plaque within each genetic risk group. [Original study]

Published on Leave a comment on Dogs Have Elevated Levels OF BPA After Eating Canned Food

 The research finding of dogs having elevated levels of the endocrine disruptor bisphenol A (BPA) from eating canned food mirrors what is happening to humans - eating canned food raises BPA levels in a person. The study also found that elevated BPA levels resulted in changes in the gut microbiome (the community of microbes living in the gut). Specifically, they found the abundance of a number of bacteria species increased or decreased depending on BPA levels in the dogs. This is not good.

This is of concern because BPA  is linked to a variety of health problems. [See all posts.] So it's best to minimize exposure to BPA, BPS, and other hormone disrupting chemicals, and also "BPA-free" products (which usually contain BPS). The BPA is in the lining of the cans used in canned food, and this leaches into the food. Unfortunately, dog food cans thought to be BPA-free in the study also contained BPA, which then leached into the dog food.  From Futurity:

Dogs have 3X more BPA after eating canned food

Researchers saw a three-fold increase in BPA levels in dogs who ate canned dog food for two weeks. They also saw changes in the dogs’ gut microbes. Bisphenol A (BPA) is a widely used industrial chemical found in many household items, including resins used to line metal storage containers, such as food cans. The chemical can disrupt hormones and is linked to a range of health problems. “Bisphenol A is a prevalent endocrine-disrupting chemical found in canned foods and beverages,” says Cheryl Rosenfeld, an associate professor of biomedical sciences in the University of Missouri College of Veterinary Medicine....

Dog owners volunteered their healthy pets for the study. Blood and fecal samples were collected prior to the dogs being placed on one of two commonly used, commercial canned food diets for two weeks; one diet was presumed to be BPA-free. Robert Backus, an associate professor in the veterinary medicine and surgery in the College of Veterinary Medicine, and other researchers on the team then analyzed the cans and the food contained in the cans for BPA levels and performed gut microbiome assessments.

“The dogs in the study did have minimal circulating BPA in their blood when it was drawn for the baseline,” Rosenfeld says.“However, BPA increased nearly three-fold after being on the either of the two canned diets for two weeks. We also found that increased serum BPA concentrations were correlated with gut microbiome and metabolic changes in the dogs analyzed. Increased BPA may also reduce one bacterium that has the ability to metabolize BPA and related environmental chemicals.”

“We share our homes with our dogs,” Rosenfeld says. “Thus, these findings could have implications and relevance to humans. Indeed, our canine companions may be the best bio-sentinels for human health concerns.”

A chemical frequently used in place of BPA called BPS (bisphenol S) and found in "BPA-free" products is also an endocrine disruptor. This also has negative health and behavioral effects. In this study the effects were seen in mice, but they are worrisome. Makes you wonder, what are all the effects in humans? From Science Daily: Plastics compound, BPS, often substituted for BPA, alters mouse moms' behavior and brain regions

In the first study of its kind, environmental health scientists and neuroscientists examined the effects of the compound bisphenol S (BPS) on maternal behavior and related brain regions in mice. They found subtle but striking behavior changes in nesting mothers exposed during pregnancy and lactation and in their daughters exposed in utero. BPS, found in baby bottles, personal care products and thermal receipts, is a replacement chemical for BPA and was introduced when concern was raised about possible health effects of that plastic compound.

Published on Leave a comment on Men Should Consider Lowering Common Chemical Exposures Before Conception

Both males and females should consider trying to lower their exposure to endocrine disrupting chemicals (hormone disrupting chemicals) when contemplating pregnancy. These chemicals are found in many personal care, food packaging, and plastic products. They can interfere with natural hormone function and are linked to a wide assortment of health problems. Evidence (like this study) is mounting that higher levels of endocrine disruptors in the body have a negative effect on the developing embryo. So men - an important time to try to lower your exposure to endocrine disruptors is the 3 months preconception (it takes about 3 months for sperm to mature), and for women it's the entire pregnancy period (from conception to birth). You can't totally avoid endocrine disrupting chemicals (they're detected in almost all of us), but you can lower your exposure.

What to avoid and what to do? Read the ingredient lists of all personal care products and try to avoid those with phthalates, parabens, triclosan, bisphenol-A (BPA), BPS, triclocarbon, and oxybenzone (BP-3). Try to buy "unscented" or "fragrance-free" products. Canned foods are considered one of the most significant routes of human exposure to bisphenol A (BPA), so limit canned foods. Note that "BPA-free" cans and plastic containers also contain endocrine disruptors. Another way to lower exposure to endocrine disruptors is to buy and store food not in plastic containers, but in glass containers or stainless steel. Don't microwave food in any sort of plastic containers. Avoid products with fragrances in them, including air fresheners and dryer sheets. Avoid flexible vinyl (e.g. shower curtains). [For all posts on endocrine disruptors, and an article from National Institutes of Health. Also check ewg.org for lists of products]. From Environmental Health News:

Are plastic chemicals in dads hurting embryos?

Turns out, moms, it's not just about you staying off alcohol and avoiding potentially harmful chemicals while pregnant or trying to become so. Your partners' exposure to plastics and packaging could play an important role in your ability to conceive a child. A father’s exposure to chemicals commonly found in plastics, personal care products and food packaging might decrease the quality of embryos produced by their sperm, according to a new study out of Massachusetts.

The study, published today in the journal Human Reproduction, is the first to examine dads’ exposure to phthalates and embryo quality through five days of in vitro fertilization (IVF). The lower quality embryos had fewer signs of the type of progress that leads to a fetus. The findings suggest men’s exposure to the chemicals—used in vinyl products, food packaging, fragrances and in other plastics to make them pliable—might hamper the development of their unborn. Embryos are the result of a fertilized egg in a woman and are the precursor to the fetus. About 12 weeks into pregnancies, the unborn is considered a fetus.

Most people have phthalates in their bodies and the compounds disrupt the endocrine system—interfering with hormones that are crucial for reproduction.While the study doesn’t prove phthalates in men lead to poor quality embryos, it adds to mounting evidence that the ubiquitous chemicals may impact pregnancies. “Sperm mature over 72 days on average, almost three months,” said senior author of the study, Richard Pilsner, an epidemiologist and assistant professor at the University of Massachusetts Amherst. “During that time, we may tell men to maybe try to avoid phthalates. There’s no way to totally escape exposure but you could minimize it.”

Led by Pilsner, researchers collected 761 immature eggs from 50 couples undergoing IVF at the Baystate Medical Center in Springfield, Mass., and checked their progression to embryos. They tested embryos at three days and five days after the eggs were fertilized, and collected urine samples from the couples on the same day as the semen sample and egg retrieval to test for phthalate metabolites, substances formed after the body processes phthalates. At day five, high exposure to phthalates in men was linked to fewer—or no—signs of the type of development that eventually leads to a fetus and placenta compared to men with lower exposure.

Phthalate exposure for fetuses has been linked to genital defects, lower IQs and miscarriages but it’s not clear what impacts this poor embryo quality could mean for the unborn. Russ Hauser, a professor of reproductive physiology at Harvard University, said in an email that the impacts might range from pregnancy loss to effects on children's health later in their life.

Shanna Swan, a professor of reproductive science at Mount Sinai Hospital in New York who was not involved in the study, said the study is limited in that it is small, and not representative of the general population because it only included couples undergoing IVF. They also didn’t see any association with the women’s exposure and decreased embryo quality. But this isn’t the first study to report a male-only effect. Higher phthalates in father’s urine was associated with an increased time for couples to conceive, according to a 2014 study. Swan said the current study was strengthened in that it is “remarkably consistent” with the 2014 study. Some phthalate metabolites linked to impacts in both studies are known to target male reproductive hormones, she said.

Published on Leave a comment on Vegan Diets During Pregnancy?

I've been asked whether vegan diets are safe during pregnancy. And I've always said that I don't know, but that avoiding all meat, fish, eggs, and dairy concerns me. Vegan diets are diets without meat, fish, dairy, honey, and eggs (no animal derived food), but while vegetarian diets also avoid meat, they do include eggs, honey, milk, and dairy products. Thus it is very important that anyone following a vegan diet plan meals carefully to get all the necessary nutrients. For example, soda and french fries are vegan, but are not good nutritionally.

There are a number of nutrients that probably need to be supplemented in vegan diets during pregnancy, especially B-12, iron, zinc, iodine (can get by using iodized salt), and omega-3s, and that's not even discussing micronutrients. So it was good to see this article by Dr. Drew Ramsey (Columbia University, NY) raising those same concerns about nutrient deficiencies during pregnancy, and pointing out that very few studies have looked at vegetarian and vegan diets in pregnancy - that the evidence is "scant". This topic is so controversial that as of today there were 85 comments by health professionals after the following Medscape article - both strongly pro and con, and studies given that show that vegans tend to have lower levels of a number of nutrients measured (zinc, iron, omega-3s, etc).

There are also reports of babies exclusively breast-fed by vegan mothers (here and here) who did not take vitamin supplements that developed nutritional deficiencies (especially B-12, vitamin K, and vitamin D). This is because what a mother eats is what the baby gets during pregnancy and breast-feeding.

On the other hand, the Academy of Nutrition and Dietetics came out with a position statement in 2016 stating that "appropriately planned vegetarian, including vegan, diets are healthful, nutritionally adequate, and may provide health benefits for the prevention and treatment of certain diseases. These diets are appropriate for all stages of the life cycle, including pregnancy, lactation, infancy, childhood, adolescence, older adulthood, and for athletes". But that article (in the Journal of Academy of Nutrition and Dietetics) then goes on in depth about several nutrients that can be lower or deficient in vegan diets unless supplements are given (B-12, iodine, etc). From Medscape;

Are Vegan and Vegetarian Diets Safe During Pregnancy?

Are vegan and vegetarian diets safe during pregnancy?....Vegan and vegetarian diets are plant-based diets....Plants, in general, are a great choice, especially colorful plants, because they tend to be more nutrient-dense. Plant-based diets have been linked to a number of health benefits, such as lower body mass index and lower rates of obesity and diabetes, as well as conferring some benefits. Certainly, vegan and vegetarian diets have higher amounts of certain nutrients like magnesium, folate, and fiber, all of which are generally consumed in very low quantities in Western diets.

Focusing on pregnancy, there are two important papers to note. The first, which got me very interested in this issue, was a series of pooled case reports by Drs Dror and Allen in 2008.[1] They looked at 30 cases of severe vitamin B12 deficiency during pregnancy in vegan women with pernicious anemia. Among the 30 vegan women who had B12 deficiency during pregnancy, about 60% of their offspring had severe developmental delays and 37% had cerebral atrophy.... The clinical importance of this is to partner with our patients who are eating plant-based diets and ensure that they have adequate levels of vitamin B12, as well as iron, zinc, and long-chain omega-3 fats during pregnancy.

The second article to take a peek at is from the British Journal of Obstetrics and Gynaecology in 2015.[2] This was a systematic review that looked at all of the literature after screening out the papers. The authors found about 13 papers focusing on maternal and infant outcomes, and about nine of those looked at nutrient deficiency. The main headline of this review is that there are no randomized clinical trials of vegan or vegetarian diets in pregnancy. It is very hard to make a clear clinical recommendation. The epidemiologic data were heterogeneous. As the researchers called it, it was "scant." That is certainly true. Overall, there were no clear associations with bad outcomes. There was some increased risk for hypospadias in one of the larger trials that looked at vegan and vegetarian diets during pregnancy.

The main concern is that vegan and vegetarian diets put patients at risk for a number of nutrient deficiencies—vitamin B12 in vegan diets (and even for vegetarians), iron, zinc, and the long-chain omega-3 fats. Just a quick moment on the long-chain omega-3 fats: Dietarily, these only come from fatty fish and seafood. They are bioconcentrated. They start in algae, but they get bioconcentrated in our food supply via seafood. It is very hard to get those during pregnancy. Certainly, a lot of healthy babies have been born to vegetarian and vegan women. You can supplement, but given the benefits we see with omega-3 fats in patients with things like mood disorders or a history of psychotic disorders, I think it is important to consider the long-chain omega-3 fats. If someone is not going to get those in their diet but has a history, risk, or propensity toward mood disorders, think about supplementation. 

Excerpts from the review study (mentioned above) in BJOG: Vegan-vegetarian diets in pregnancy: danger or panacea? A systematic narrative review.

To review the literature on vegan-vegetarian diets and pregnancy outcomes [in healthy pregnant women]....None of the studies reported an increase in severe adverse outcomes or in major malformations, except one report of increased hypospadias in infants of vegetarian mothers. Five studies reported vegetarian mothers had lower birthweight babies, yet two studies reported higher birthweights. The duration of pregnancy was available in six studies and was similar between vegan-vegetarians and omnivores. The nine heterogeneous studies on microelements and vitamins suggest vegan-vegetarian women may be at risk of vitamin B12 and iron deficiencies.

CONCLUSIONS: The evidence on vegan-vegetarian diets in pregnancy is heterogeneous and scant. The lack of randomised studies prevents us from distinguishing the effects of diet from confounding factors. Within these limits, vegan-vegetarian diets may be considered safe in pregnancy, provided that attention is paid to vitamin and trace element requirements.

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Published on 1 Comment on Erectile Dysfunction, Exercise, and Periodontitis

 Two recent reviews of studies looked at erectile dysfunction from different angles. The first review found that regular exercise or physical activity improves erectile function  (especially if the person has heart disease or has had their prostate removed) - with improvements similar to what people see with a medication. Other studies have found similar results (see here and here). The other review found that having chronic periodontitis (gum disease) is linked to a higher incidence of erectile dysfunction, with one study finding that treating the periodontitis improves erectile dysfunction symptoms. Bottom line: get regular physical activity and exercise, and get regular dental care (and treat any periodontitis).

From Medscape: Erectile Dysfunction May Improve With Exercise

Men who have difficulty maintaining erections may benefit from exercise or physical activity, according to a new analysis. A growing body of evidence has suggested physical activity could improve erectile function, but the authors of the new report say that until now, no one had looked at all the studies together....The prevalence of erectile dysfunction ranges from 8 percent among men in their 20s and 30s, up to 37 percent among men in their early 70s.

For the new study, the researchers searched for randomized controlled trials testing exercise and physical activity as a therapy for erectile dysfunction. They found seven studies published between 2004 and 2013 that included a total of 505 men, who were tracked for anywhere from eight weeks to two years. Average ages ranged from 43 to 69 years. Altogether, 292 men were randomly assigned to complete aerobic exercises, pelvic floor muscle exercises or a combination of exercises. The other 213 men were not told to exercise.

Erectile function was measured using the International Index of Erectile Function. Scores range from 5 to 25; men with no erectile dysfunction have scores of 22 to 25, and those with the most severe dysfunction score between 5 and 7. Overall, men who exercised had their scores increase by an average of 3.85 points, compared to men who did not exercise. Exercises specific to pelvic floor muscles didn't seem to yield a benefit. Among men with an increased cardiovascular risk, coronary heart disease or prostate removal, however, any type of exercise led to improved erectile function scores.

A take-home message from this analysis is that exercise should have a role in the treatment of erectile dysfunction, said Dr. Landon Trost, who is head of andrology and male infertility at the Mayo Clinic in Rochester, Minnesota....He told Reuters Health that the average increase in erectile function score would likely be similar to what people see with a medication.

From Medscape: Periodontitis Tied to Risk of Erectile Dysfunction

Erectile dysfunction is more common in men with chronic gum disease, according to a new review of existing studies. Periodontitis has been tied to a higher risk of cardiovascular disease and general inflammation, which in turn have been tied stroke and atherosclerosis, which are associated with erectile dysfunction (ED). 

The reviewers analyzed data from five studies published between 2009 and 2014, including one randomized controlled trial. In total, the studies covered 213,000 participants aged 20 to 80. Each study found erectile dysfunction was more common among men being treated for chronic periodontitis, particularly for those younger than 40 and older than 59. After accounting for diabetes, which can influence both gum disease and sexual function, erectile dysfunction was 2.28 times more common for men with periodontitis than for men without it, according to the report in the International Journal of Impotence Research....One study in 2013 found that treating periodontitis improves erectile dysfunction symptoms.

The new review did have limitations, including the fact that erectile dysfunction and chronic periodontitis are caused by similar risk factors, such as aging, smoking, diabetes mellitus and coronary artery disease. While some studies did account for diabetes, most did not account for smoking or alcohol consumption, which can also affect oral health and sexual function, the authors write. Even after an exhaustive search, the evidence linking periodontitis and ED is limited, they write. 

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New research further confirms a link between higher lutein levels (as measured in the blood) and the preservation of "crystallized intelligence" in older adults.  Crystallized intelligence is the ability to use the skills and knowledge one has acquired over a lifetime. Lutein is in foods such as leafy green vegetables, cruciferous vegetables (broccoli, brussels sprouts, cauliflower, and cabbage) and egg yolks. Lutein is also found in small amounts in other fruits and vegetables. Bottom line: eat a variety of fresh fruits and vegetables daily. [Original study.]Medical Xpress:

Study links nutrition to brain health and intelligence in older adults

A study of older adults links consumption of a pigment found in leafy greens to the preservation of "crystallized intelligence," the ability to use the skills and knowledge one has acquired over a lifetime.

Lutein (LOO-teen) is one of several plant pigments that humans acquire through the diet, primarily by eating leafy green vegetables, cruciferous vegetables such as broccoli, or egg yolks, said University of Illinois graduate student Marta Zamroziewicz, who led the study with Illinois psychology professor Aron Barbey. Lutein accumulates in the brain, embedding in cell membranes, where it likely plays "a neuroprotective role," she said. "Previous studies have found that a person's lutein status is linked to cognitive performance across the lifespan," Zamroziewicz said. 

The study enrolled 122 healthy participants aged 65 to 75 who solved problems and answered questions on a standard test of crystallized intelligence. Researchers also collected blood samples to determine blood serum levels of lutein and imaged participants' brains using MRI to measure the volume of different brain structures. The team focused on parts of the temporal cortex, a brain region that other studies suggest plays a role in the preservation of crystallized intelligence.

The researchers found that participants with higher blood serum levels of lutein tended to do better on tests of crystallized intelligence. Serum lutein levels reflect only recent dietary intakes, Zamroziewicz said, but are associated with brain concentrations of lutein in older adults, which reflect long-term dietary intake. Those with higher serum lutein levels also tended to have thicker gray matter in the parahippocampal cortex, a brain region that, like crystallized intelligence, is preserved in healthy aging, the researchers report..... "Our findings do not demonstrate causality," Zamroziewicz said. "We did find that lutein is linked to crystallized intelligence through the parahippocampal cortex."