Dr Chanzig Guela, of Northwestern University in Chicago, described the results of brain pathology exams in older people (80-year-olds) who had high-quality mental functioning. The subjects had to have a cognitive performance test result equivalent to that of a 50-year-old, be fully involved in personal and social activities, and have a major accomplishment, such as writing a book, after age 80.

On autopsy, the brains of 5 such high-functioning elders had only 25% the amount of tangles as the brains of 6 elderly people who had shown cognitive decline (but no dementia). On the other hand, beta-amyloid plaques seemed to be more extensive in the 5 high-functioning 80-year-olds than in the 6 controls.

Obviously, the numbers in this study are extremely small – the differences were not enough to reach statistical significance, and certainly not enough to draw definite conclusions. However, they suggest that there is a possible roll for accumulation of tangles in the causation of cognitive impairment and dementia. This may be sufficient for pharmacological researchers to switch their research direction to give tangles more attention than they have in the past . . .

Twelve studies were identified that compared fiber intake with a placebo or no treatment at all. They included 590 patients, 20% to 90% of whom were women. The specific fiber used in 6 of the studies was ispaghula husk, or psyllium. In these, 64% of the placebo or no treatment patients had persistent symptoms during and after treatment. With the psyllium treatment, only 52% had continued symptoms, so that there was a 13% reduction in frequency of persistent symptoms. The number-needed-to-treat was 6. Bran showed no benefit over placebo.

Twenty-two studies examined the effectiveness of 12 different antispasmodic drugs, in 1775 patients. Overall, 56% of the placebo patients in these studies had persistent symptoms during and after treatment, compared with 39% given antispasmodics, representing a reduction of 32%, and a number-needed-to-treat of 5. The most effective antispasmodics were otilonium (not available in the USA) and hyoscine (Buscopan®).

Finally, 4 studies compared peppermint oil with placebo, in 390 patients. Of those taking the peppermint oil, 25% had persistent IBS symptoms, compared with 65% of the placebo patients. This shows a reduction in symptoms of 57%, on average, and a number-needed-to-treat of 2.5.

These meta-analyses showed clearly that all 3 selected treatments were effective in IBS, with peppermint oil as the best, antispasmodics as second best, and added fiber in third place. Remember that there are other approaches to management, without necessarily involving prescription medications – e.g. dietary modification (avoiding gas-producing foods, adding more fiber), and symptomatic treatment of diarrhea (loperamide or Imodium®) or constipation (laxatives). There are many excellent web sites about IBS, but be careful – not all treatments are well-tested, and most ‘cures’ are expensive and don’t work. One of the better sites is that of the IFFGD.

The researchers, who came from Beth Israel Deaconess Medical Center in Boston, studied the effects of two iPod brands (Nano and Shuffle) on 60 patients with implanted pacemakers or defibrillators. While the iPods had no effect, their headphones produced interference in 23% of the subjects – inappropriate pacing in 4 out of 27 pacemaker patients, and inhibition of defibrillator action in 10 of 33 patients.

The magnetic field strength varies considerably with different brands of headphones, but, more important, the magnetic field strength falls off very rapidly with distance. However, it should be remembered that the magnetic field is always “on”, whether or not the iPod is switched on.

So, all you cardiac patients with implanted devices, who also like to listen to music on the move, please ensure you keep the headphones in your pants pocket rather than in your shirt breast pocket; and make sure your spouse or child removes any headphones before laying their head on your chest.

Over 700 patients who were hospitalized with for a first episode of deep venous thrombosis or a pulmonary embolism were asked if they had had a flu shot in the last year. They were compared with an equal number of control subjects, matched for gender and age, who were also hospitalized but without thrombotic disease.

After factors such as body weight, oral contraceptive use, and varicose veins had been controlled for, having a flu shot was linked with a 26% reduction in the subsequent risk of having a venous thrombosis episode. The reduction was actually 48% in those patients younger than 52, which was the average age of the persons in the study.

The researchers hadn’t designed the study to find out why (or how) flu vaccination reduces the risk of venous thrombosis. One theory mentioned was that ‘protected’ patients might spend fewer days ill in bed (a known cause of thrombosis). Or perhaps an infection like influenza has a direct pro-thrombotic influence. Either way, it’s a positive finding that should encourage those doubters to go to the flu-shot clinic, straight away.

This study measured non-fasting triglycerides; this may not be the usual type of sample, as triglycerides are usually determined on fasting blood samples. Elevated non-fasting triglycerides have been implicated in coronary artery disease, so it seemed pertinent for the researchers to look at a relationship with ischemic stroke. Thirty-year data from almost 14,000 men and women between 20 and 93 were analyzed.

The subjects were classified according to their non-fasting triglyceride levels above 89 mg/dL. Those with a level between 89 and 176 mg/dL had a 30% higher risk of ischemic stroke; between 177 and 265 mg/dL a 60% increase (men) or 100% increase (women); between 266 and 353 mg/dL a 50% (men) or 40% increase (women); and between 354 and 442 a 120% (men) or 150% increase (women).

Clearly, raised triglyceride levels must be added to the list of risk factors for stroke. Both men and women stroke victims averaged non-fasting levels about 40 mg/dL higher than people without stroke. There are effective ways to lower a raised triglyceride level, so don’t ignore the problem; ask your doctor for advice and, if necessary, the appropriate medication.

The University of Maryland researchers carried out a randomized cross-over study in 10 healthy adults; they were non-smokers, and averaged 36 years of age. An important feature was that the music should be enjoyable to the subject, and be compared with other stimuli – anxiety-provoking music, watching a humorous video, and listening to a relaxation tape. First, the volunteers selected 30 minutes of music they enjoyed. Then, they were asked to avoid listening to this particular music for 2 weeks before the study began. They were also asked to identify music that made them feel anxious (the sound-track to “Psycho” or "Jaws", maybe?).

To measure endothelial function, flow-mediated dilatation in the upper arm artery (brachial artery) was determined before and after 30 minutes of each test stimulus. The four stimuli were given on separate occasions, one week apart, for 30 minutes. The results showed that, compared with baseline, flow-mediated dilatation;

Increased 26% after enjoyable music

Decreased 6% after anxiety-provoking music

Increased 19% after watching a funny video

Increased 11% after hearing a relaxation tape

The size of increased flow-mediated dilatation – 26% - was roughly equal to that produced by aerobic physical activity or statin medication.

Previous reports have also shown that laughter – your own – can improve your cardiovascular health. This explains the good result from the humorous video in this study. Anyhow, if you’re stuck with your iPod rather than a DVD, you’ll do better – provided the music is something joyful!

After 6 months treatment, the women using the higher testosterone dose patch reported a significant increase in the number of satisfying sexual episodes over the final 4-week period compared with baseline values; the increase averaged an additional two episodes per month. Those using the 150 microgram patch had an average of an additional 1.2 episodes per month, and placebo recipients had a smaller increase (0.7 episodes/month). Both testosterone doses levels increased sexual desire scores and reduced personal distress, compared with placebo.
Averse effects of the treatment included unwanted hair growth with the 300 microgram testosterone level; it was reported in 30% of the patients at that level compared with 23% of those on placebo.
Although the women were followed for a total of 18 months, the study wasn’t adequate to define the possible side effects of this form of hormone treatment. For instance, 4 of the testosterone-treated subjects developed breast cancer, although in one it was subsequently found to be present before the study started, and the other three all occurred in the first 4 months of the study. None of the placebo subjects developed cancer. The investigators of the study say the improvement in sexual desire was “modest but meaningful", but they think further studies are needed to clarify the safety profile of longer-term use of the patch.

The relevant findings are posted in BioMedCentral Neuroscience. A weak current is applied by electrodes to the scalp. The effect is to stimulate or depress the underlying brain neurons, depending on the polarity of the current. Application of a depressive current over the non-dominant motor cortex (usually that on the left side) and a stimulating current over the dominant side was found to improve volunteers to improve their scores on key-board numbers input by 16%.

These findings, obtained in healthy volunteers, suggest strongly that a similar approach could be used in stroke victims to improve controlled movement in a non-dominant hand. Maybe there is a role for the application of electrodes to the skulls of some patients, after all!

This was a study conducted by Spanish and North American researchers, who analyzed the urinary frequency in 884 recently-diagnosed bladder cancer patients from hospitals in Spain. There were 996 control patients selected from hospitals in the same areas. Interviews were done to gather information on the frequency of nighttime urination.

There was a consistent decrease in the risk of bladder cancer with increasing nighttime urination, in both men and women. Going at least twice a night was associated with a halving of the risk. The increased risk associated with smoking was also reduced with nighttime urination, by about half.

The protective effect of nighttime urination on bladder cancer risk strongly suggests that the latter is related to the contact time between carcinogenic substances in the urine with the cells lining the bladder. The big question for Americans concerns the amount of carcinogens in their urine (as opposed to Spanish subjects). Perhaps a similar study needs to be conducted in the USA, to determine the relevance of urinary carcinogens for bladder cancer here.

]]>Statins Really Do Reduce the Risk of Alzheimer’shttp://www.health-and-age.org/health-topics/2008/11/14/statins-really-do-reduce-the-risk-of-alzheimers.htmlRobert Griffith2008-11-14T10:00:55ZAlzheimer'sMillions of people are taking a statin drug – statins are probably the highest-selling medications in the USA. The main purpose is to reduce a person’s low-density lipoprotein cholesterol (LDL-C), but some doctors prescribe them for their apparent ability to slow, or even reverse, atherosclerosis, and hence lower the risks of cardiovascular disease. There have been isolated reports that statin-users are less likely to have Alzheimer’s disease, but prospective controlled studies have so far provided inconsistent results. That has changed, however, with a report from the Netherlands’s Rotterdam Study, just published in the British Medical Journal. Almost 7,000 participants in the Rotterdam Study were followed from baseline in 1990-1993 until 2005, to see which ones developed Alzheimer’s. All their filled prescriptions were searchable in national pharmacy records. Upon each Alzheimer’s diagnosis, the subject was classified as an ‘any user’ or ‘never-user’ of cholesterol-lowering medication; the ‘any users’ were sub-classified into lipophilic statin users, hydrophilic statin users, and takers of non-statin cholesterol-lowering drugs. (Lipophilic means fat-soluble and thus able to cross into the brain; hydrophilic means water-soluble and thus unable to cross the blood-brain barrier.)

There were 582 cases of Alzheimer’s disease over the 9 years. Any statin use (compared to never use of cholesterol lowering drugs) was linked to a decreased risk of Alzheimer’s – 43% less. The findings were the same for both lipophilic and hydrophilic statins. There was no corresponding reduction for the users of non-statin cholesterol lowering drugs.

This study confirms previous positive findings, and answers two questions: is the effect due to a lowering of cholesterol by any means? And, if it’s due to a statin, does the statin have to be lipophilic?

A US pharmaceutical company, Nymox, holds US and global patent rights for the use of statin drugs for the prevention and treatment of Alzheimer’s disease. It seems unlikely that they will make a fortune from this, as many statins are now generics and prescribed widely by doctors without too much attention being paid to the actual indication. As this study shows, ‘any’ statin seems to work in nearly halving the risk of developing Alzheimer’s over the next 9 years, on average. Not a cure for this dread disease, but a preventive step in the right direction. It remains to be seen if physicians start prescribing statins for this purpose, without waiting for FDA approval of the indication . . .

]]>A High Blood Pressure May be a Good Thing in the Very Oldhttp://www.health-and-age.org/health-topics/2008/11/13/a-high-blood-pressure-may-be-a-good-thing-in-the-very-old.htmlRobert Griffith2008-11-13T10:00:14ZHeart Health Clinical TestsSwedish geriatricians have done a study of the very old (85 years and above) and their blood pressure, in relation to their mortality. The results are published in the Journal of the American Geriatrics Society.

The 350 participants were from six areas in the north of Sweden. They were classified by age into 3 groups: 85 to 89, 90 to 95, and above 95. Information on blood pressure, mental tests, body weight, medical diagnoses, medications taken, and 4-year mortality were collected.

The systolic and diastolic blood pressures and the pulse pressure (the difference between the two) were lower in those people dying within 4 years. The systolic blood pressure was the strongest predictor – levels below 120 mmHg were linked to greater all-cause mortality both alone and when corrected for underlying health conditions. A systolic blood pressure level of 164 mmHg was calculated to be associated with the lowest mortality rate.

This finding, if confirmed in other studies, will reinforce the existing tendency for many geriatricians to back off somewhat in their efforts to ‘treat’ high blood pressure in the very old. As the authors of this study suggest, the optimal systolic blood pressure for people over 85 may well be above 140 mmHg.

]]>CRP Is Not a Villain, Merely a ‘Biomarker’ or Signalhttp://www.health-and-age.org/health-topics/2008/11/12/crp-is-not-a-villain-merely-a-biomarker-or-signal.htmlRobert Griffith2008-11-12T10:00:13ZHeart Health Other Health Problems

Increased blood levels of C-reactive protein (CRP) are linked with increased risks of coronary artery disease and stroke, as well as with conditions of inflammatory changes in the body. Not surprisingly, it has been questioned whether a raised CRP causes coronary artery disease. A study reported in the New England Journal of Medicine seems to have laid this idea to rest.

Danish physicians started from the premise that people with different genetic makeup are naturally likely to have different levels of CRP. So they genetically tested 50,000 people to see if those with higher CRP levels had higher risks of heart disease. They found that the risk of coronary heart disease and ischemic cerebrovascular disease (the predecessor of stroke) were 1.6 and 1.3 times, respectively, in those persons with a CRP above 3 mg/L, compared with those whose CRP was below 1 mg/L. And in those persons with lifelong high levels of CRP due to genetic variations, where the theoretical increased risk of coronary heart disease and ischemic cerebrovascular disease would be increased up to 32% and 25%, respectively, there was no actual increased risk of vascular disease. This study has sufficient numbers to refute the concept that raised CRP levels cause coronary artery disease or ischemic cerebrovascular disease. This is important, as at least two pharmaceutical companies are working on a CRP-inhibitor or blocker (Isis Pharmaceuticals and Takeda/Millenium). It would seem they are ‘barking up the wrong tree’ – but we’ve been wrong before.

]]>Your End-of-Life Choiceshttp://www.health-and-age.org/health-topics/2008/11/11/your-end-of-life-choices.htmlRobert Griffith2008-11-11T10:00:45ZOther Health ProblemsEveryone should have someone who can make health decisions for them – a health power-of-attorney – especially if they are a boomer or older. They should also have a written expression of their wishes regarding life-sustaining treatment: in particular, how extensive life-saving interventions should be, given the likelihood of a painful closing process. It’s not enough, however, to make such ‘advance directives’ once, and then put them aside indefinitely. This is shown by a recent study of preferences for life-sustaining treatment at different times in the same person. It’s described in the Archives of Internal Medicine.

Over 800 physicians who graduated from Johns Hopkins Hospital between 1948 and 1964 were contacted, and completed questionnaires in 1999 and again in 2002. Their average age in 1999 was 69. During the 3-year interval between the questionnaires, the choices selected for life-sustaining treatment changed somewhat. They were asked about their wishes for these interventions: cardiopulmonary resuscitation, mechanical ventilation, IV fluids, a feeding tube, dialysis, chemotherapy, major surgery, invasive tests, blood or blood products therapy, and antibiotics, they were given choices classified as ‘most aggressive’ (most of the interventions), ‘intermediate’ (only IV fluids and antibiotics), and ‘least aggressive (most everything declined). Those physicians who did not have advance directives at baseline were more likely to select the ‘most aggressive’ options at 3 years.

Of those who had wanted the most aggressive treatment at baseline, 59% made a different choice at follow-up 3 years later. Half those who chose intermediate care originally chose another option (“most” or “least aggressive”) 3 years later. While 20% of the original “least aggressive” group at baseline wanted a change to another level. This shows that options change over time – within a relatively short period, at that. So make advance directives, but take them out and look at them every 3 to 5 years, as your views may have changed, especially if you’ve had the experience of watching a close friend or family member in their final illness.

]]>Vitamin K Slows Insulin Resistance, But Only in Menhttp://www.health-and-age.org/health-topics/2008/11/10/vitamin-k-slows-insulin-resistance-but-only-in-men.htmlRobert Griffith2008-11-10T10:00:38ZNutrition Other Health Problems DiabetesVitamin K is known sometimes as the "coagulation" vitamin - it's a fat-soluble oily substance that's required for the synthesis of several proteins needed for both coagulation and anticoagulation. It's given to infants at birth to help prevent brain hemorrhage. Many rat poisons are made of anti-vitamin K substances, leading to lethal hemorrhage in their victims. Vitamin K is found in a number of foods, including leafy greens, cauliflower, and liver. However, the chief source is synthesis by bacteria in the large intestine, and in most cases, absence of dietary vitamin K is not a health problem.

Now a new potential use has been found for vitamin K. Tufts University scientists, reporting in the journal Diabetes Care, were conducting a study of vitamin K on bone loss in older people, where it may have therapeutic value. As an add-on to this study, insulin resistance was measured, along with fasting glucose and insulin levels, after 3 years' administration to 350+ men and women aged 60-80. The subjects were not diabetic at the start of the study.

Insulin resistance (a precursor of type 2 diabetes) was significantly lower in the men taking vitamin K supplements at their 3-year visit, but not at their 6 month visit, nor in the women at any time. The scientists suggest that women may not have reacted in the same way to vitamin K, because their fatty tissue might store the vitamin in a form that was unavailable for body tissues.

This study yields an interesting effect that deserves follow-up, although it has no immediate practical importance. No need to go out and buy some liver for dinner, unless that's your fancy.

A strain of mice that develop atherosclerosis more rapidly than normal were used in the study, which was reported in the British Journal of Nutrition. Dried plum powder was fed to such mice over a 5-month period at a dose equivalent to a human eating 10 to 12 prunes a day. By the end of the study, there was a reduction in the area of atherosclerosis in the entire arterial system, compared with mice not fed the powder.

It seems that the fiber pectin in prunes may reduce cholesterol levels (it does in humans), which resulted in less atherosclerosis. I guess the next step is to see if prunes eaten in this quantity can reduce atherosclerosis formation in humans . . . Or researchers must find out the constituent in prunes that is so effective, purify and/or synthesize it (or a close relative), and get the FDA to approve it.