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Category: healthy aging

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Several recent studies found that air pollution has a negative effect on the brain. This study of elderly women in North Carolina found that long-term exposure to higher levels of air pollution (specifically fine particulate matter smaller than 2.5 micrometers (called PM2.5) resulted in smaller brain volumes (especially the brain's white matter). They studied elderly women (aged 71 to 89), but the findings should be of concern to everyone exposed to high levels of air pollution.  White matter connects brain regions (with nerve fibers that pass signals throughout the brain) and determines how information is processed in the brain. The researchers pointed out that other recent studies reported that high air pollution is linked to cognitive decline and accelerated brain aging. From Futurity:

AIR POLLUTION MAY SHRINK BRAIN’S WHITE MATTER

Exposure to air pollution may have a negative impact on how the brain’s white matter ages. Older women who lived in geographic locations with higher levels of fine particulate matter in ambient air had significantly smaller white matter volumes across a wide range of brain areas, new research shows.

Fine particulate matter is smaller than 2.5 micrometers and is known as PM2.5, a form of pollution that easily enters the lungs and possibly the bloodstream. White matter connects brain regions and determines how information is processed in the brain....“Our study provides convincing evidence that several parts of the aging brain, especially the white matter, are an important target of neurotoxic effects induced by long-term exposure to fine particles in the air.”

The study found that older women ages 71 to 89 who had lived in places with greater PM2.5 exposures had significantly smaller volumes of white matter and that this could not be explained by the geographic region where they lived, their race or ethnic background, socioeconomic status, lifestyle, or medical conditions that may also influence brain volumes.

The researchers performed brain magnetic resonance imaging scans of 1,403 women who are part of the Women’s Health Initiative Memory Study (WHIMS), a nationwide report based at Wake Forest Baptist Medical Center in Winston-Salem, NC. The researchers also used residential histories and air monitoring data to estimate the participants’ exposure to air pollution in the previous six to seven years.

White matter contains nerve fibers and connects brain regions with each other by traveling deep within and passing nerve signals throughout the brain. Gray matter is primarily composed of neuronal cell bodies, dendrites, glial cells, and capillaries. The study did not find impacts from exposure to air pollution in participants’ gray matter.

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People fear dementia and Alzheimer's disease, because they are progressive diseases that nothing treats successfully. However, in the past year there have been some studies showing improvements with lifestyle changes (not cures, but for some the progression was slowed or showing some improvements).

The latest studies found that exercise (especially aerobic execise) had some beneficial effects on those with mild cognitive impairment (MCI), Alzheimer's disease, and vascular cognitive  impairment (VCI): neuropsychiatric improvements, improvements in biomarkers for the disease, and improved blood flow to the brain. From Medscape:

Physical Activity May Help Treat Dementia

New research shows that being physically active not only reduces cognitive decline and improves neuropsychiatric symptoms in patients with dementia but may actually reduce Alzheimer's disease (AD) biomarkers, including amyloid and tau protein in the brain. Exercise could also benefit patients with types of dementia other than AD, another study suggests.Some of this promising new research on exercise was presented at the Alzheimer's Association International Conference (AAIC) 2015. 

Danish researchers had already presented cognition-related results of the multicenter ADEX study ...The intervention consisted of 1 hour of aerobic exercise three times a week for 16 weeks. The control group received usual care..... The analysis found that these [neuropsychiatric] symptoms improved in the 66 patients in the "high exercise"group... The NI is a 12-item questionnaire that rates, among other things, depression, apathy, agitation, hallucinations, irritability, weight loss, and sleep."We saw that the control group got worse; there was a small decline in this group, which you would expect because this is progressive disease," said Steen Hasselbalch, MD, Danish Dementia Research Centre, Copenhagen, Denmark. "But the intervention group remained at the same level and even got a little better, so at end of the intervention there was a significant difference."

The question arises of whether exercise could not just delay worsening of symptoms but actually change brain pathology.The answer, suggests other research, is yes. In a separate study presented at the AAIC 2015, researchers found decreased phosphorylated tau (P tau) in older, previously sedentary persons completing a 6-month regimen of moderate- to high-intensity aerobic exercise.

The study enrolled 70 patients aged 55 to 89 years with prediabetes as well as amnestic mild cognitive impairment (MCI)....We think they are at high, high risk for developing dementia of the Alzheimer's type." These patients were randomly assigned to the aerobic exercise group or to the stretching group. Those in the aerobic group started slowly — 10 minutes of exercise a week — and gradually built the time and intensity up over 6 weeks to the point where they were exercising 45 minutes a day, 4 days a week, at 75% to 85% of their maximum heart rate...."This group had a choice of exercises: treadmill, stationary cycling, elliptical trainer, or preapproved group classes.

The stretching group, whose members could do balance exercises, gentle yoga, and other approved classes in addition to stretching, maintained a maximum heart rate of below 35%. All exercises were adapted to the needs and limitations of individual patients and were done at a local YMCA.

The researchers looked at biomarkers in cerebrospinal fluid (CSF), including P tau protein and amyloid β 42....Most intervention trials don't show such changes in P tau. "But we saw it with exercise and no medications," said Dr. Baker. "Exercise was enough to move a biomarker that indicates the severity of the disease."  It wasn't surprising, she added, that this was true only for older patients. "It may be that before age 70, you have a lot of compensatory mechanisms that help to maintain brain health, and after 70, those start breaking down."

The study also showed that the aerobic activity increased blood flow to the brain...The researchers demonstrated that the increased blood flow was in regions characteristically affected by aging and AD (ie, memory and processing). Cognitive benefits were particularly noteworthy for executive function..."Our brain imaging results are just fantastic; they show some really nice increases in blood flow in the areas of brain that support executive function and areas of the brain that normally show decreased flow for people with MCI, so it's reversing the blood flow detriment in MCI."

AD may not be the only dementia potentially treatable through exercise. Another study discussed at the meeting showed that this intervention may help those with vascular cognitive impairment (VCI). It's the first intervention trial to suggest that exercise can improve cognition in patients with confirmed VCI, said Teresa Liu- Ambrose, PhD, Canada Research Chair, University of British Columbia, Vancouver, Canada, who reported the results.The 6-month study included 71 patients aged 56 to 96 years with mild VCI of varying physical capacities. They were assigned to usual care that included a nutrition component or to an intervention of moderate-intensity walking, 3 times a week for an hour....In a subset of patients who had neuroimaging, there was "evidence of efficiency" in the brain of those who exercised, Dr Liu-Ambrose told Medscape Medical News.

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Recently I've seen a number of published studies that found benefits to someone being bilingual or benefits in learning a new language. Some benefits recently found in bilinguals (or the "billngual advantage"): more gray matter in the executive control area of the brain, 4 to 5 year delay in onset of Alzheimer's symptoms, processing of information more efficiently and more easily, and young bilingual children are more likely to think that everything is learned (while monolinguals more likely to think things are innate). From Science Daily:

Bilinguals of two spoken languages have more gray matter than monolinguals

A new study published in the journal Cerebral Cortex suggests people who speak two languages have more gray matter in the executive control region of the brain...Early on, bilingualism was thought to be a disadvantage because the presence of two vocabularies would lead to delayed language development in children. However, it has since been demonstrated that bilingual individuals perform better, compared with monolinguals, on tasks that require attention, inhibition and short-term memory, collectively termed "executive control."

This "bilingual advantage" is believed to come about because of bilinguals' long-term use and management of two spoken languages. But skepticism still remains about whether these advantages are present, as they are not observed in all studies...."Given this concern, we took a different approach and instead compared gray matter volume between adult bilinguals and monolinguals. We reasoned that the experience with two languages and the increased need for cognitive control to use them appropriately would result in brain changes in Spanish-English bilinguals when compared with English-speaking monolinguals. And in fact greater gray matter for bilinguals was observed in frontal and parietal brain regions that are involved in executive control."

Gray matter of the brain has been shown to differ in volume as a function of people's experiences. A prominent finding of this type was a report that London taxi drivers have more gray matter in brain areas involved in spatial navigation.

What about being bilingual leads to these advantages?....The researchers compared gray matter in bilinguals of American Sign Language (ASL) and spoken English with monolingual users of English...."Unlike the findings for the Spanish-English bilinguals, we found no evidence for greater gray matter in the ASL-English bilinguals," Olulade says. "Thus we conclude that the management of two spoken languages in the same modality, rather than simply a larger vocabulary, leads to the differences we observed in the Spanish-English bilinguals."

Science Daily: Bilingualism delays Alzheimer's manifestation by more than four years

The symptoms of Alzheimer disease (AD) manifest themselves about four to five years later in bilinguals as opposed to monolinguals. In bilinguals, the disease onset was estimated at the age of 77, while in monolinguals, this was at the age of 73.

From Science Daily:  Bilingual brains better equipped to process information

Speaking more than one language is good for the brain, according to new research that indicates bilingual speakers process information more efficiently and more easily than those who know a single language. The benefits occur because the bilingual brain is constantly activating both languages and choosing which language to use and which to ignore, said a researcher.

From Science daily:  Bilingualism changes children's beliefs

Most young children are essentialists: They believe that human and animal characteristics are innate. That kind of reasoning can lead them to think that traits like native language and clothing preference are intrinsic rather than acquired. But a new study suggests that certain bilingual kids are more likely to understand that it's what one learns, rather than what one is born with, that makes up a person's psychological attributes.

White and gray matter of the human brain. Credit: Medline Plus, US National Library of Medicine

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Eating green leafy vegetables and other brightly colored fruits and vegetables containing vitamin K, lutein, folate and beta-carotene were linked to keeping the brain healthy in older adults and slowing cognitive decline. Researchers found that older people who ate one to two servings per day had the cognitive ability of a person 11 years younger than those who consumed none. From Science Daily:

Eating green leafy vegetables keeps mental abilities sharp

Something as easy as adding more spinach, kale, collards and mustard greens to your diet could help slow cognitive decline, according to new research. The study also examined the nutrients responsible for the effect, linking vitamin K consumption to slower cognitive decline for the first time...."Since declining cognitive ability is central to Alzheimer's disease and dementias, increasing consumption of green leafy vegetables could offer a very simple, affordable and non-invasive way of potentially protecting your brain from Alzheimer's disease and dementia."

The researchers tracked the diets and cognitive abilities of more than 950 older adults for an average of five years and saw a significant decrease in the rate of cognitive decline for study participants who consumed greater amounts of green leafy vegetables. People who ate one to two servings per day had the cognitive ability of a person 11 years younger than those who consumed none. When the researchers examined individual nutrients linked with slowing cognitive decline, they found that vitamin K, lutein, folate and beta-carotene were most likely helping to keep the brain healthy.

To conduct the study, Morris' research team gathered data from 954 participants from the Memory and Aging Project, which aims to identify factors associated with the maintenance of cognitive health. The participants, whose age averaged 81, reported their daily food and beverage intake by answering a detailed 144-item questionnaire at the beginning of the study.... They followed participants for 2 to 10 years, assessing cognition annually with a comprehensive battery of 19 tests and adjusted for age, sex, education, smoking, genetic risk for Alzheimer's disease and participation in physical activities when estimating the effects of diet on cognitive decline.

"With baby boomers approaching old age, there is huge public demand for lifestyle behaviors that can ward off loss of memory and other cognitive abilities with age," said Morris. "Our study provides evidence that eating green leafy vegetables and other foods rich in vitamin K, lutein and beta-carotene can help to keep the brain healthy to preserve functioning." In addition to green leafy vegetables, other good sources of vitamin K, lutein, folate and beta-carotene include brightly colored fruits and vegetables.

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The following article excerpts are from the talk "Food and Brain" about the best foods for the brain, at the annual 2015 meeting of the American Psychiatric Association (APA). This is in the new emerging field of food psychiatry, or how certain foods and diet influence the brain. The data is emerging that we can positively influence mental health through dietary interventions. For ex.: recent work reported that adults who followed the Mediterranean dietary pattern the closest over 4.4 years had a significantly reduced risk of developing depression (by 40% to 60%).

One key comment was: "Perhaps diet is the closest we've come to prevention in psychiatry." Some foods that are especially beneficial for the brain: seafood, greens, nuts, legumes (beans) and occasional dark chocolate. Use smaller amounts of meat (more as flavorings rather than just eating huge chunks of it) on top of a plant based diet. Also mentioned were the benefits of turmeric (because of the curcumin in it) and rosemary. And focus on improving the whole dietary pattern rather than just eating or not eating certain foods.

Note that BDNF is Brain-derived neurotrophic factor. This is a protein that acts on the brain, the nervous system, and it is very important for learning, memory, and higher thinking. So increasing BDNF levels is good. And remember, what's good for the brain is also good for the body and microbes - it's all intertwined. From Medscape:

Beans, Greens, and the Best Foods For the Brain

Dr Ramsey, in collaboration with the new International Society for Nutritional Psychiatry, is in the process of developing a standardized "brain food diet." "Food is a very effective and underutilized intervention in mental health," he started off. "We want to help our patients have more resilient brains by using whole foods...by helping get patients off of processed foods, off of white carbohydrates, and off of certain vegetable oils."

Though the field is in its infancy, food psychiatry is increasingly being embraced by clinicians and researchers, as a paper published earlier this year in the Lancet Psychiatry attests. "Although the determinants of mental health are complex," the authors wrote, "the emerging and compelling evidence for nutrition as a crucial factor in the high prevalence and incidence of mental disorders suggests that diet is as important to psychiatry as it is to cardiology, endocrinology, and gastroenterology." ..."The data are very promising that we can positively influence mental health through dietary interventions," commented Dr Ramsey.

"Hominid diets have changed drastically through millions of years of evolution.,,,But only in the past 100 years has our diet drastically switched from a whole foods diet to one that is more processed and high in refined carbohydrates; that includes more vegetable fats rather than meat fats; and preservatives, emulsifiers, and other additives, which appear to have contributed to a decline in our collective health.

Early humans evolved in the African Rift Valley, which is near a seacoast. It's possible that whatever evolutionary spark occurred that made us human occurred here, in part due to reliable access to seafood—oysters in particular—which glutted our brains with omega-3 fatty acids and cholesterol (our brains are composed of 60% fat). Oysters and other mollusks are also very high in nutrients, including B12, which is commonly deficient in people consuming vegan or vegetarian diets and is necessary for myelin and neurotransmitter function. 

A number of studies have linked the Mediterranean diet (high in fish oils, nuts, and grains and including maybe a little red wine) with advantageous effects on neurologic and mental health. Dr Deans cited recent work reporting that adults who followed the Mediterranean dietary pattern the closest over 4.4 years had a significantly reduced risk of developing depression (40%-60%)....When taken together, most of these dietary pattern studies, which have been conducted all over the world, consistently show that traditional, pre-processed diets are the healthiest, including for the brain. ..."Eat the rainbow," he says, given that bold, bright colors in nature tend to signify valuable vitamins and phytonutrients (the reds, purples, and greens in particular).

Seafood: Seafood is packed with brain-healthy omega-3 fatty acids. These healthy fats are also abundant in plants like chia and flax, but plant-based sources aren't as efficiently converted to docosahexaenoic acid (DHA), an important structural component of neuronal membranes. DHA also influences the expression of brain-derived neurotrophic factor (BDNF), which can benefit people who have mood and anxiety disorders. Bivalves like mussels, oysters, and clams are the top source of vitamin B12 as well as zinc: Six oysters (only about 10 calories each) provide 240% of our recommended daily B12 intake and 500% of our recommended zinc intake! Seafood is also a leading dietary source of vitamin D (we don't get it all from the sun) as well as iodine and chromium. Although many people worry about mercury in fish, Dr Ramsey provided an easy way around the concern: Eat small fish like sardines, anchovies, and herring, which typically don't accumulate toxic levels.

Leafy greens: A great base for a brain-food diet, leafy greens are a good source of fiber, folate (derived from the wordfoliage), magnesium, and vitamin K. Perhaps surprising, kale, mustard greens, and bok choy provide the most absorbable form of calcium on the planet, more so than milk. Greens also provide flavanols and carotenoids that have beneficial epigenetic influences (eg, including upping hepatic toxin processing). 

Nuts:... Nuts are packed with healthy monounsaturated fats. They help keep us full and also aid in absorbing fat-soluble nutrients. Nuts also provide fiber as well as minerals like manganese and selenium. A serving of 22 almonds (just 162 calories) contains 33% of our recommended vitamin E, plenty of protein, and minerals, including iron. One study from 2013 found that the Mediterranean diet augmented with nuts is associated with significantly higher BDNF levels in patients with depression.

Legumes: Dr Ramsey is pro-meat, but he acknowledges that many people are eating far too much and the wrong types of meat, and that nuts and legumes are a great alternative source of protein and nutrients...Some data suggest that vegan and vegetarian diets are associated with improved mood. But as previously mentioned, these dietary patterns can result in B12 deficiency, which has been associated with brain atrophy and developmental delay. Hence, supplementation is important in this population. Vegetarianism has also been linked with depression, anxiety, and eating disorders, as well as increased healthcare utilization and worse quality of life. These negative associations also could be due to the fact that it's harder to absorb nutrients like zinc, iron, and certain omega-3s from plants.

"The notion that the vegan diet is the healthiest diet on the planet is probably incorrect," said Dr Ramsey, before explaining that he just feels that we should approach meat in our diets differently....We want to help patients use beef and seafood more as flavorings on top of a plant-based diet." A modest amount of meat in the diet has its benefits, including nutrient availability: Hemoglobin-derived iron is up to 40% more absorbable than plant-based iron. Unlike most plants, meat provides all of the amino acids necessary for protein synthesis. Dr Ramsey emphasized the importance of seeking out leaner, grass-fed meats if one has the means.

The understanding of how microbiota contribute to our mental and medical well-being is rapidly advancing....One of the most powerful interventions to alter our microbiome is diet. Research shows that stressed mice experienced changes in the gastrointestinal microbiota, reflecting the gut-brain relationship. There are 260 million neurons connecting the gut and the brain; furthermore, many commensal gut bacteria make neurotransmitters and communicate with the brain via the vagus nerve....Although the science of probiotic therapies is relatively young, it's clear that these commensal organisms co-evolved with us and are adapted to our diet.

Finally, to close out the session, Dr Ramsey returned to the stage and asked, "So, can you eat to build a better brain? We think that you can if you focus on dietary patterns and not a single food here or there." He also reminded the audience to help their patients identify and increase their consumption of nutrient-dense foods and to "eat the rainbow,"..."I don't know of anything else that can potentially decrease the risk of depression in a population by 40%," he concluded. "Perhaps diet is the closest we've come to prevention in psychiatry."

...Evidence suggests that curcumin, an ingredient in turmeric, increases BDNF. Other research has found that populations that eat more curry have a decreased risk for dementia, while rosemary extract may help prevent cognitive impairment. "Many spices seem to have healing properties," Dr Ramsey commented.

Although the "Food and the Brain" session at the American Psychiatric Association annual meeting focused on what to eat in the interest of brain health, intermittent fasting might also be beneficial for the brain. In addition to helping maintain a healthy weight, fasting induces ketosis. Ketone metabolism has been shown to be beneficial for the brain and improve cognition in patients with mild cognitive impairment or Alzheimer disease. Keep in mind that fasting can come with risks for some people, particularly diabetics, and should be discussed with a healthcare provider.

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There used to be alternative medicine, but it has evolved to what is now called integrative medicine. There are integrative centers even at some if the most prestigious medical institutions in the USA (Harvard, Mayo Clinic,etc). Integrative medicine is part of the medical establishment, so there is an emphasis on treatments that can be scientifically investigated, and conventional medical treatments are also used as needed. But there is a concern with wellness, with looking at the whole body, at prevention and treating chronic diseases (such as heart disease and diabetes) that take years to develop and are tied to the ways people think, feel, and live their everyday lives (so they look at stress, diet, lifestyles).

What I especially like is the quote taught in medical schools: “A common homily we tell our students is that in five years, half of what we taught them will be wrong. We just don’t know which half.” That alone is a good reason for a person to take responsibility for living the most healthy lifestyle that they can (to focus on wellness and prevention), rather than depending on medicines for "treatments" and "cures". Excerpts from The Atlantic:

The Evolution of Alternative Medicine

Back in the 1990s, the word “alternative” was a synonym for hip and forward-thinking.... That was the decade when doctors started to realize just how many Americans were using alternative medicine, starting with a 1993 paper published in The New England Journal of Medicine. The paper reported that one in three Americans were using some kind of “unconventional therapy.” Only 28 percent of them were telling their primary-care doctors about it.

Enough Americans had similar interests that, in the early 1990s, Congress established an Office of Alternative Medicine within the National Institutes of Health. Seven years later, that office expanded into the National Center for Complementary and Alternative Medicine (NCCAM), with a $50 million budget dedicated to studying just about every treatment that didn’t involve pharmaceuticals or surgery—traditional systems like Ayurveda and acupuncture along with more esoteric things like homeopathy and energy healing.Some thought the NCCAM’s work was too far outside the mainstream....

In an email, Briggs confirmed that her center’s mission has shifted over the years...”That change became more pronounced a few months ago, when Congress removed the word “alternative” from the NCCAM’s name, redubbing it the National Center for Complementary and Integrative Health (NCCIH). 

The idea of alternative medicine—an outsider movement challenging the medical status quo—has fallen out of favor since my youth. Plenty of people still identify strongly with the label, but these days, they’re often the most extreme advocates, the ones who believe in using homeopathy instead of vaccines, “liver flushes” instead of HIV drugs, and garlic instead of chemotherapy. In contrast, integrative doctors see themselves as part of the medical establishment. “I don’t like the term ‘alternative medicine,’” says Mimi Guarneri, a longtime cardiologist and researcher who founded the Academy of Integrative Health and Medicine as well as the integrative center at Scripps. 

After visiting the NIH center and talking to leading integrative physicians, I can say pretty definitively that integrative health is not just another name for alternative medicine. There are 50 institutions around the country that have integrative in their name, at places like Harvard, Stanford, Duke, and the Mayo Clinic. Most of them offer treatments like acupuncture, massage, and nutrition counseling, along with conventional drugs and surgery.

The actual treatments they use vary, but what ties integrative doctors together is their focus on chronic disease and their effort to create an abstract condition called wellness. In the process, they’re scrutinizing many therapies that were once considered alternative, subjecting them to the scientific method and then using them the same way they’d incorporate any other evidence-based medicine.

It’s hard to talk about integrative health without using abstract terms like wellness, vitality, and healing...For a long time, though, the medical profession was so busy treating acute illness that it didn’t put as much attention on preventing heart disease, diabetes, or cancer...The bigger problem, says Hyman, is that most doctors aren’t well equipped to treat chronic disease. “We have an acute-disease system for a chronic-disease population,” he told me. “The whole approach is to suppress and inhibit the manifestations of disease.” 

The question is how integrative doctors try to restore balance—and the answer varies. Many of them focus on diet to a degree that goes far beyond the usual guidelines about avoiding salt or trans fat. They’ll look for undiagnosed food sensitivities or hormonal imbalances, with the idea that these problems account for many chronic health complaints and cause even more serious breakdowns over time. There’s a lot of emphasis on intestinal bacteria. “We now know that so many separate things are linked to what’s going on in the gut,” Hyman told me, alluding to a growing body of literature linking the microbiome to everything from cancer to mood disorders. Guarneri, the cardiologist who founded the integrative center at Scripps, told me integrative health is highly personalized. 

Integrative doctors tend to favor treatments that are—as Briggs, the NCCIH director, put it—“amenable to scientific investigation.” Several of the doctors I interviewed told me they don’t prescribe homeopathic remedies, for instance, because there’s no evidence to support them....When integrative doctors do employ alternative-seeming treatments, it’s usually to manage pain or reduce stress. 

Aside from these variations, there’s another reason it’s hard to define integrative health: It doesn’t exist in a vacuum. Its practitioners are part of the same medical establishment as other doctors, going to the same conferences and publishing in the same journals. They’ve influenced and been influenced by major trends in medicine—for instance, the movement toward patient-centered medicine, or the backlash against the overuse of drugs and surgery that the New Yorker writer Atul Gawande calls “the epidemic of unnecessary care.”

Data: CDC Report on Multiple Chronic Conditions Among Adults; Chart: Lauren Giordano / The Atlantic

When Blackwelder teaches family medicine at East Tennessee University, he says he reminds his students to stay open to treatments that once seemed esoteric, as long as they show some promise. “A common homily we tell our students is that in five years, half of what we taught them will be wrong. We just don’t know which half,” he says. “We find things out by remaining inquisitive, being open to exploring new ideas when a question is asked. We should never just say we’ve got it all figured out, because we rarely do.”At a time when one in two American adults has at least one chronic disease, it’s safe to say there are a lot of things medicine still hasn’t figured out. 

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Foods with trans fats. Credit: Wikipedia.

Finally the FDA is phasing out the use of artificial trans fats in foods (found in partially hydrogenated vegetable oils) within 3 years. It turns out that even though for many years scientists and the medical community pushed foods such as margarine (which have trans fats) as healthier than saturated fats such as butter, they were wrong. Instead the trans fats are linked to cardiovascular problems.

We can thank 100 year old Frank Kummerow for the ban, and for warning about trans fats for six decades! He is still drinking whole milk, eating eggs and butter, but he does avoid "fried foods, margarine, and anything associated with partially-hydrogenated oils". Other foods that are currently viewed as healthy by the medical community are extra virgin olive oil and coconut oil. However, please note that canola oil, currently viewed as a healthy and safe alternative to partially hydrogenated oils, also contains trans fats (due to the manufacturing process) and should be avoided. Also keep in mind that companies are allowed to say they have zero trans fat of they contain less than 0.5 grams per serving (which means the trans fats can add up over the course of a day). From The Washington Post:

The 100-year-old scientist who pushed the FDA to ban artificial trans fat

No one was more pleased by the Food and Drug Administration's decision Tuesday to eliminate artificial trans fats from the U.S. food supply than Fred Kummerow, a 100-year-old University of Illinois professor who has warned about the dangers of the artery-clogging substance for nearly six decades."Science won out," Kummerow, who sued the FDA in 2013 for not acting sooner, said in an interview from his home in Illinois. "It's very important that we don't have this in our diet."

In the 1950s, as a young university researcher, Kummerow convinced a local hospital to let him examine the arteries of people who had died from heart disease. He made a jarring discovery. The tissue contained high levels of artificial trans fat, a substance that had been discovered decades earlier but had become ubiquitous in processed foods throughout the country.

Later, he conducted a study showing that rats developed atherosclerosis after being fed artificial trans fats. When he removed the substance from their diets, the atherosclerosis disappeared from their arteries.

Kummerow first published his research warning about the dangers of artery-clogging trans fats in 1957. More than a decade later, while serving on a subcommittee of the American Heart Association, he detailed the massive amounts of trans fat in the shortening and margarines lining grocery shelves, and helped convince the food industry to lower the content in certain products.

Despite Kummerow's research and warnings over the years, artificial trans fats remained a staple of processed food for decades. Well into the 1980s, many scientists and public health advocates believed that partially hydrogenated oils were preferable to more natural saturated fats. And the food industry was reluctant to do away with artificial trans fats, which were cheaper than their natural counterparts, extended shelf life and gave foods desirable taste and texture.

Frustrated by the lack of action, Kummerow filed a 3,000-word citizen petition with the FDA in 2009, citing the mounting body of evidence against trans fat. The first line read: "I request to ban partially hydrogenated fat from the American diet."

In the 1990s, more and more studies had shown that trans fats were a key culprit in the rising rates of heart disease. The advocacy group Center for Science in the Public Interest also petitioned the FDA in 1994 to require that the substance be listed on nutrition labels -- a move that the agency put into place in 2006. In 2002, the Institute of Medicine found that there was “no safe level of trans fatty acids and people should eat as little of them as possible.” As the dangers of trans fat became clearer, public opinion also shifted, and food companies increasingly removed the substance from products, though it remained in a broad range of foods, from cake frostings to baked goods.

Four years after filing his petition and hearing nothing, Kummerow sued the FDA and the Department of Health and Human Services in 2013, with the help of a California law firm. The suit asked a judge to compel the agency to respond to Kummerow's petition and "to ban partially hydrogenated oils unless a complete administrative review finds new evidence for their safety."

Three months later, the FDA announced its plans to effectively eliminate trans fats by saying that the substance no longer would be assumed safe for use in human foods. Tuesday's action finalizes that initial proposal, and manufacturers will have three years to reformulate products or to petition the agency for an exception.

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New research finding health benefits to humans from a four day low calorie diet - the Fasting Mimic Diet (FMD). Cutting calories to 34 to 54% of normal for a few days is obviously much easier to do than actual fastiing, so these results look very promising. In summary: the researchers found that in a small human trial, three cycles of this diet given to 19 subjects once a month for five days decreased risk factors and biomarkers for aging, diabetes, cardiovascular disease and cancer (and with no major adverse side effects). Three earlier posts on various types of minifasting health benefits: Minifasting May Benefit Health, Health Benefits of Feast and Famine Diet, Fasting and the Immune System. From Science Daily:

Diet that mimics fasting appears to slow aging

Want to lose abdominal fat, get smarter and live longer? New research led by USC's Valter Longo shows that periodically adopting a diet that mimics the effects of fasting may yield a wide range of health benefits. In a new study, Longo and his colleagues show that cycles of a four-day low-calorie diet that mimics fasting (FMD cut visceral belly fat and elevated the number of progenitor and stem cells in several organs of old mice -- including the brain, where it boosted neural regeneration and improved learning and memory.

The mouse tests were part of a three-tiered study on periodic fasting's effects -- testing yeast, mice and humans...Mice, which have relatively short life spans, provided details about fasting's lifelong effects. Yeast, which are simpler organisms, allowed Longo to uncover the biological mechanisms that fasting triggers at a cellular level. And a pilot study in humans found evidence that the mouse and yeast studies were applicable to humans.

In a pilot human trial, three cycles of a similar diet given to 19 subjects once a month for five days decreased risk factors and biomarkers for aging, diabetes, cardiovascular disease and cancer with no major adverse side effects, according to Longo.

The diet slashed the individual's caloric intake down to 34 to 54 percent of normal, with a specific composition of proteins, carbohydrates, fats and micronutrients. It decreased amounts of the hormone IGF-I, which is required during development to grow, but it is a promoter of aging and has been linked to cancer susceptibility. It also increased the amount of the hormone IGFBP-, and reduced biomarkers/risk factors linked to diabetes and cardiovascular disease, including glucose, trunk fat and C-reactive protein without negatively affecting muscle and bone mass.

Longo has previously shown how fasting can help starve out cancer cells while protecting immune and other cells from chemotherapy toxicity. 'It's about reprogramming the body so it enters a slower aging mode, but also rejuvenating it through stem cell-based regeneration,' Longo said. 'It's not a typical diet because it isn't something you need to stay on.'

For 25 days a month, study participants went back to their regular eating habits -- good or bad -- once they finished the treatment. They were not asked to change their diet and still saw positive changes. Longo believes that for most normal people, the FMD can be done every three to six months, depending on the abdominal circumference and health status. For obese subjects or those with elevated disease risk factors, the FMD could be recommended by the physician as often as once every two weeks. His group is testing its effect in a randomized clinical trial, which will be completed soon, with more than 70 subjects.

Despite its positive effects, Longo cautioned against water-only fasting and warned even about attempting the fasting mimicking diet without first consulting a doctor and seeking their supervision throughout the process....Longo also cautioned that diabetic subjects should not undergo either fasting or fasting mimicking diets while receiving insulin, metformin or similar drugs. He also said that subjects with body mass index less than 18 should not undergo the FMD diet.

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Looks like another procedure is found not to be beneficial and possibly harmful - this time arthroscopic surgery as a treatment for the middle aged or older person with a painful arthritic knee or torn meniscus (the shock absorbing cartilage between the knee bones). The researchers also found that "exercise therapy" had more benefits. From Medical Xpress:

Benefit of knee surgery for middle aged or older patients 'inconsequential', say experts

The benefit of surgery for middle aged or older patients with persistent knee pain is inconsequential and such surgery is potentially harmful, say researchers in a study published in The BMJ this week.Their findings do not support arthroscopic surgery as a treatment for the middle aged or older person with a painful arthritic knee or torn meniscus (the shock absorbing cartilage between the knee bones).

The article is part of The BMJ's Too Much Medicine campaign - to highlight the threat to human health and the waste of resources caused by unnecessary care. Over 700,000 knee arthroscopies (a type of keyhole surgery) are carried out in the USA and 150,000 in the UK each year on middle aged and older adults with persistent knee pain. Yet the evidence for arthroscopic surgery is known to be weak, with all but one published trials showing no added benefit for surgery over control treatment.Despite this, many specialists are convinced of the benefits of surgery.

So researchers based in Denmark and Sweden reviewed the results of 18 studies on the benefits and harms of arthroscopic surgery compared with a variety of control treatments (ranging from placebo surgery to exercise) for middle aged and older people with persistent knee pain.s.

Overall, surgery was associated with a small but significant effect on pain at three and six months (but no longer) compared with control treatments. No significant benefit on physical function was found. A further nine studies reporting on harms found that, although rare, deep vein thrombosis (DVT) was the most frequently reported adverse event, followed by infection, pulmonary embolism (a blockage of the main artery of the lung), and death.

"Interventions that include arthroscopy are associated with a small benefit and with harms," say the authors, and the benefit is "markedly smaller than that seen from exercise therapy." These findings "do not support the practice of arthroscopic surgery as treatment for middle aged or older patients with knee pain with or without signs of osteoarthritis," they conclude.

"It is difficult to support or justify a procedure with the potential for serious harm, even if it is rare, when that procedure offers patients no more benefit than placebo," argues Professor Andy Carr from Oxford University in an accompanying editorial.

 

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A wonderful commentary by Dr. Mandrola about recent research of almost 500,000 UK citizens. Researchers found that just asking the patient several basic questions was a better predictor of 5 year mortality than all sorts of blood tests, measurements, and analyses. The best basic questions were: Is your health excellent, good, average, or poor? Is your walking pace slow, average, or brisk? Along with smoking, those two basic questions were the best predictors of staying alive in the next 5 years. These excerpts are from Medscape:

Health Is Not Complicated—Just Ask the Patient

It turns out predicting health is not so complicated. Nor is it digital at all. For persons of middle age (40 to 70 years), self-reported overall health and walking speed were the best predictors of death in the next 5 years, according to a study published this week in the Lancet.[1]

In an analysis of nearly 500,000 UK citizens followed for 5 years, these two simple questions outperformed 655 measurements of demographics, health, and lifestyle. Is your health excellent, good, average, or poor? Is your walking pace slow, average, or brisk? Along with smoking, those two basic questions, inquiries that hardly require a digital device, were the best predictors of staying alive in the next 5 years.

Pause for a moment here and ponder the beauty of that top-line result. Half a million people followed for 5 years; 655 measures of health, including heart rate, blood pressure, and lab tests, and the best predictors were that simple.

In the 5 years of follow-up, 8532 (1.7%) subjects died. Overall, cancer was the most common cause of death (53% in men; 69% in women). The most common cancer-related cause of death was lung cancer in men (n=546) and breast cancer in women (n=489). Cardiovascular disease was the second leading cause of death (26% in men; 33% in women).

 

There were gender differences in predictors of death. Self-reported health was the strongest predictor of death in men (C index 0.74). In women, a previous cancer diagnosis was the strongest predictor (C index 0.73).Self-reported walking pace was a strong predictor of death in both men and women (C index 0.72 and 0.69, respectively.) For example, a man aged 40 to 52 years who reported a slow walking pace was 3.7 times more likely to die than a similarly aged man who reported a steady walking pace. In a large subset of subjects with no reported health conditions, smoking was the best predictor of mortality.

 

The final, and perhaps niftiest, aspect of this study was that researchers developed an 11 to 13 question risk prediction score, which they then put on an interactive website. Anyone can answer these simple questions and get their health-related age relative to the UK population. The researchers call this age the UK Longevity Explorer (UbbLE) age.

I am drawn to these findings because they emphasize something that is increasingly lost on both doctors and patients. True health is not complicated. And the big picture is still useful.Any experienced clinician will testify that patients know when they are well and when they are not. The finding that self-reported health predicts death urges clinicians, generalists and specialists alike, to ask our patients how they feel about their health.

Then there is the matter of self-reported walking pace. How easy it is to be distracted by digital data. We walk into the exam room to see our patient. He is still. We look at him. We poke and listen to his body. We assess his ECG and other measures. Soon we will review his smartphone metrics and DNA data. Yet we tend to forget the obvious: to move is to be healthy. Drs Ganna and Ingelsson teach us that to move briskly may be healthier.