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Aging and Chronic Illness Healthy Lifestyles
Ernest H. Rosenbaum, MD

Diet and Nutrition

Alzheimer's Disease
Healthy Lifestyles for Chronic Illness: Heart, Diabetes, Stroke, Cancer and Possibly Alzheimer's Disease.

Diet and Nutrition
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Diet and weight are major preventive and supportive care topics. Unfortunately, despite the desire to eat a healthy, nutritious diet, it's not being implemented into a daily behavior modification, as Americans still eat an unbalanced, calorie-dense diet.

Calories are excessive, portions too large, and frequently are not optimally nutritious. The result is a public health problem of progressive USA obesity with increase in body mass index. Despite public awareness of this problem and weight loss strategies, including bariatric surgery, losing weight remains a constant problem. Of note is that bariatric procedures, including stomach stapling and bypass surgery, have risen from 13,000 in 1998 to 200,000 in 2006.

Eating berries is a healthy dietary supplement. The recommended two cups a week provides adequate phytochemicals that may reduce oral, esophageal, and breast cancer problems. With age, the body needs more help in controlling free radicals, which cause oxidative stress. Phenols in berries (plant compounds) have good antioxidant properties. They reduce damage to DNA and reduce blood vessel formation and thus potentially have vascular endothelial growth factor (VEGF) properties. Berries are also rich in calcium, selenium, and vitamins A, C and E. There have also been some research reports that many in the berry family inhibit growth and appear to stimulate death in human oral, prostate and colon cancer cells in test tube studies.

The advice is to eat the berries themselves rather than supplements with berry extracts, berry drinks, or freeze-dried powders. Three to four half cup servings of berries a week may help boost an anticancer program.

Antioxidant Supplements
In an analysis initially of 747 trials, Blumberg did an analysis (at Tufts-Freedman School of Nutrition, Science and Policy), of a subgroup of 47 trials of 180,938 participants. The antioxidant supplements overall were associated with a 5% increased relative risk of all-cause mortality, a statistically small effect. Some studies did suggest that antioxidants might reduce cardiovascular disease and help prevent some cancers. Results from several large-scale clinical trials had been mixed.

Breast Cancer Survivors and Longevity Survival
The WHEL Study - Women's Healthy Eating and Living - was a study with increased vegetables, fruit and fiber consumption and reduced fat intake. 3,088 women were enrolled under age 55. One group had dietary counseling. Phytochemicals in fruits and vegetables, such as carrots and sweet potatoes, can be converted to vitamin A, and the lutein in green, leafy vegetables and lycopene from tomatoes are also carotenoids. There was an 82% increase in vegetable intake and 18% in fruit intake. They were also encouraged to do regular exercises, not smoke, and limit alcohol.

Cancer patients often have more depression and fatigue, and psychological evaluations were also elevated with improved fighting spirit and decreased anxiety, hopelessness, and fatalism. The control group received educational materials.

This study will end with the final evaluations in the year 2007.

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Fitness and Balance
Aches, pain, weakness, deconditioning and the fear of falling often make people, who are ill, avoid exercising. Yet, those who do exercise, especially balance exercises, can help reverse the deconditioning process and improve balance.

Research studies in hospitalized, nursing home, and inactive adults between 70 and 90 (424 seniors), who had lost a great deal of their independent functioning, were put into an exercise program. They experienced less than 20 minutes of exercise a week and had low scores for balance, walking, and the ability to rise from a chair. After six months of programmed physical activity, they had increased endurance, strength, flexibility and the ability to balance. There was a control group that had health education programs on nutrition, foot care, and preventive services. The group that exercised had significant improvement, and many became not only independent but improved their quality of life (Richard J. Hodes from the National Institute on Aging).

It was of interest that simple exercises assigned by David M. Koceja, Ph.D., at Indiana University, Bloomington, provided a 15-minute routine four days a week of a balance training program.
1. Participants needed an area where they could hold on for balance if needed.
2. They were taught to focus on the opposite wall when balancing.
3. With both feet flat on the floor spread shoulder-distance apart, placing weight on one knee and lifting the other leg, initially an inch or two, later higher. Holding for fifteen seconds was the goal. Repeat with other leg.
4. With weight on one leg, lift the other leg, straight kneed, to the side and back. Try holding at a 45-degree angle for fifteen seconds. Repeat with the other leg.
5. The stork stance by placing weight on one leg and reaching forward with the same arm, lifting the other leg straight back, trying to keep the back straight and maintaining balance for fifteen seconds. Return to the standing position. Repeat with the opposite leg.
6. Standing in a corner, try to balance on one leg for fifteen to twenty seconds, and then, alternate to the other leg for another fifteen to twenty seconds. This may be repeated over a three to five-minute period.

Reference: Newsletter from The American Institute of Cancer Research, Summer 2007.

Alzheimer's Disease
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As we age, it is normal to lose some of our memory functions - get forgetful. There are many kinds of dementia, and Alzheimer's is one of these. A neurologic psychiatric evaluation for those with cognitive decline is merited.

Diagnosing Alzheimer's disease - 7 warning signs:
1. Repeating the same question many times.
2. Repeating the same word or story repeatedly.
3. Forgetting daily functions: cooking, repairs, playing cards or routine activities.
4. Inability to handle finances: paying bills, balancing checkbook.
5. Misplacing household objects, keys, or getting lost in familiar surroundings.
6. Not bathing, wearing the same clothes repeatedly, yet insisting they have bathed or that their clothes are clean.
7. Not making decisions - relying on spouse or family - or answering questions they would have handled themselves. (Source:

1. One out of five people between 75 and 84 has Alzheimer's disease.
2. Two out of five people older than 85 have Alzheimer's.
3. The chances of dementia may be reduced with healthy lifestyles, including diet and brain exercises.
4. As we age, our testable memory scores decrease - this is known as cognitive decline.

There are many factors involved in Alzheimer's disease. It is a chronic disease like heart disease and is somewhat similar to brain arteriosclerosis with narrowed or clogged arteries (stroke-like), which has also been called vascular dementia.

Healthy Lifestyles for Chronic Illness: Heart, Diabetes, Stroke, Cancer and Possibly Alzheimer's Disease
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1. Increase intake of fish with polyunsaturated Omega-3 fats DHA (Docosahexaenoic acid) and EPA (eicosapentaenoic acid) to at least three times a week. DHA and EPA are high protecting oils that may also be brain protective. DHA is a common fat in nerve cells and is decreased in Alzheimer's disease. DHA does cross the blood-brain barrier and may help nourish nerve cells. In the Framingham Heart Study, those eating fish three times a week had half the amount of dementia than those eating less. Omega-3 fats help protect patients with high blood pressure, and low HDL cholesterol, and high triglycerides.
Thus, there is an association between increased DHA consumption and improved cognition, as well as heart disease. The goal is to eat fatty fish (salmon, herring) about five ounces a week versus thirty ounces of leaner fish (cod, haddock, or tuna). Fish oil or vegetarian Omega-3 (phytoplankton) is an option.

2. Reduce saturated and trans fats from your diet.
In the Chicago Health and Aging Project (CHAP), there was twice the risk of Alzheimer's in those eating the most saturated fats (25 gm per day) versus the least. Those eating 1.8 gm of trans fats doubled their risk. Increase in the saturated fat, palmitic acid, correlated with cognitive decline.
Statin drugs may help protect against Alzheimer's (the cholesterol-transport gene apoE e4).

3. Green vegetables
Iceberg and romaine lettuces, kale, and spinach may help reduce the cognitive decline. There is no correlation with fruits. Three servings per day correlated with a 40% slower rate of cognitive decline (CHAP study).
Studies at Tufts University showed blueberry extracts helped decrease amyloid-rich plaques in rats, who performed better in maze testing. No human data is available.

4. Vitamin E
There is thus far no data that 600 IU vitamin E affected cognition. Of note is that beta-carotene, C, E, and zinc helped reduce the risk of macular degeneration.
There is some data suggesting that vitamin E-rich foods may help reduce the cognitive decline of Alzheimer's disease (vegetable oils, nuts, seeds, green vegetables, and whole grains).
Of note is that gamma tocopherol is anti-inflammatory.

5. Reduce or control diabetic risk
The goal is to have a fasting blood sugar less than 100, as pre-diabetics have a blood sugar between 100 and 125. Diabetics have a fasting blood sugar greater than 125. Pre-diabetics may have a higher risk of cognitive decline - 64% higher versus 79% higher in diabetics. Diabetics with insulin resistance have a higher risk of heart disease and cognitive decline, "like being ten to fifteen years older" (Grodstein - Harvard School of Public Health). Diabetes promotes small vessel arterial sclerosis affecting heart, brain and the body. Higher insulin levels (type 2 diabetes) promote senile brain plaques with amyloid (insulin may reduce amyloid breakdown).

6. Weight control
Weight control, exercise, and a healthy prudent diet is recommended. In addition to diabetes, excessive weight can be related to increasing dementia in later life, as there is information that the fat cells release hormones causing inflammation that can damage the brain. In a study at Kaiser by Kristine Yaffe (10,000 patients), middle-aged, overweight people thirty-six years later had increased vascular dementia and Alzheimer's disease. Overweight was correlated with larger waists and poor cognition a dozen years later in the Framingham Heart Offspring Study. There is a more rapid brain aging. Overweight also correlates with cancer, heart disease, stroke, and diabetes.

7. Exercise
In the Nurses' Health Study at Harvard, 16,000 women had cognition tests, and those who exercised with increased physical activity had better test scores. They estimated aging two to three years faster. Those who were most active had better test scores (a half hour a day of brisk walking, but even slower walking was found to reduce the risk {Grodstein}).
Exercise helps lower blood pressure, insulin resistance, and thus potentially healthier arteries.

8. Controlling blood pressure
Increased blood pressure is related to heart disease and mini-strokes. There is no proven link to Alzheimer's disease thus far. Of note is that with Alzheimer's disease, there is a decrease in blood pressure, cholesterol and weight.

In middle age, increased blood pressure, weight and cholesterol are risk factors not only for heart disease but dementia. In a Finnish study (1,450 middle-aged men and women), those with high blood pressure had twice the risk of Alzheimer's disease and dementia.

9. Cognitive brain stimulation
There is a decreased risk in Alzheimer's disease and dementia in older people, who do intellectually stimulating work. Going to museums, the library, concerts, attending classes or lectures, playing chess or writing letters and articles appear to be important. Higher education appears to promote better cognition. Those with Master's and Doctor's degrees do better than those with a Bachelor's degree (Grodstein).

Thus, brain exercises appear to be protective. The environment in which you live can also make a difference in brain stimulation. Training for a more active brain (ten sessions) of memory, reasoning and speed processing appear to be positive (Reference: JAMA, 296: 2805, 2006).

10. The role of depression
Yaffe notes that depression may play a prominent role associated with dementia. Those with serious depression did worse on their cognitive testing.
Classical symptoms of depression - a feeling of worthlessness, helplessness, boredom, fearful, hopeless or that life appeared to be empty. Fatigue (feeling tired), lack of appetite, and insomnia are less common symptoms in older people.
Being depressed affects your thought process. Studies are being contemplated to test depression and cognitive function in those taking anti-depressive medicines.
Not all aging people feel either miserable or depressed. Treating depression may also improve quality of life.

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