Brain aging and memory loss due to Dementia and Alzheimer's disease with the medical icon of a group of color changing autumn fall trees in the shape of a human head losing leaves as a loss of thoughts and intelligence function.

Can Alzheimer’s disease be treated with ketones?

Brain aging and memory loss due to Dementia and Alzheimer's disease with the medical icon of a group of color changing autumn fall trees in the shape of a human head losing leaves as a loss of thoughts and intelligence function.

The brain’s main fuel source is glucose. However, it has been shown that the brains of people who have Alzheimer dementia (AD) are not able to utilize glucose as well as normal people. When there is not enough glucose to meet it’s metabolic needs, the neurons that work the hardest, i.e. those involved with memory and cognition are the first ones to be compromised and thus show impairment. So the question is: is there another fuel that the brain can use?

The answer luckily is yes! Ketone bodies (KB) or ketones are another fuel source for the brain and the body. Acetoacetate and Beta-hydroxybutrate are collectively known as ketone bodies (KB). KB are normal metabolites that are manufactured by the liver as an alternative fuel for the body and the brain when dietary sources of carbohydrates are in short supply, a process called ketosis. Ketone bodies can be produced in healthy individuals either during times of fasting or by eating a ketogenic diet. The ketogenic diet was first introduced, over 80 years ago, as a dietary treatment of uncontrolled epilepsy in children. The ketogenic diet is diet consisting of high amounts of fat and low amounts of carbohydrates. Other ways of producing ketones nutritionally are by eating high amounts of medium chain triglycerides (MCTG) such as coconut oil repetitively throughout the day.

When ketones are available they are a better fuel source for the brain in patients with AD for several reasons. First of all ketones do not need insulin for uptake into the cell, so it is easier for the brain to get this fuel source compared to glucose. This decrease usage of glucose is visible on brain PET scans, which look at the uptake of glucose. In patients with early AD, there is a 14% overall decrease in the uptake of glucose compared to normal controls. In contrast, when these same patient are placed in brain PET scans looking at the uptake of ketones, the uptake is the same both in the patients with early AD and normal controls.

Other possible theories on way ketones are a better source of fuel for patients with AD is that they are a more efficient source of energy. First of all ketones produce more energy (ATP) compared to glucose. Secondly, the mitochondria, the cells that produce the body’s energy, are believed to be impaired in patients with AD. Ketones, however, are able to bypass the blocked site of the energy pathway, the Krebs cycle, in the mitochondria. This allows the mitochondria to produce energy more efficiently when it is fueled with ketones.

There have been several published clinical studies looking at the effects of ketosis in patients with mild cognitive impairment and AD. The results have shown improved cognitive performance in patients who are in ketosis either from eating a ketogenic diet or from a diet consisting of very high dose of MCTG oils (20- 70 g/day). This improvement in memory was positively correlated the urinary ketone levels, i.e. the higher the level of ketones in the body, the better the cognitive effect.

Even more exciting than the fact that the ketogenic diet has been shown to help memory in people with AD, is that there is also evidence that being in ketosis might also have some disease modifying benefits in AD. In mouse models of AD, a ketogenic diet has been shown to actually improve the pathology associated with AD. Specifically, the mouse brains were found to have less beta- amyloid formation and less phospholated tau protein formation, the neuropathology associated with AD. Ketones have also been shown to have a neuro-protective effect on the hippocampal neurons from both glutamate and amyloid beta toxicity. The hippocampi in rats that are fed a ketogenic diet have also have an increase amount of mitochondria. The neuro-protective effect thus may result from enhanced energy reserves, which improves the ability of the neurons to resist metabolic challenges. Another possibility is that ketone metabolism as compared to glucose metabolism generates less free radicals and lower oxidative stress, thus resulting in improved antioxidant capacity, decrease CNS inflammation, and thus less cell death.

There are potentially 2 problems associated with the ketogenic diet. 1) It is very difficult to adhere to, especially in people who have dementia, who are not self motivated to stick with the diet. 2) Eating a high carbohydrate meal while on the ketogenic diet would potentially throw the person out of therapeutic ketosis and it   may take a day or two to get back in, thus taking several days before seeing any benefits again. Up until now the only other alternative to the ketogenic diet to produce therapeutic ketosis is the repetitive ingestion of high does of MCTG. The problem with it is: the doses high enough to produce therapeutic ketosis are often associated with significant GI side effects. Additionally, taste of MCTG is often difficult to swallow.

Luckily now there is a better way. There is a now a ketone supplement available to the public. This supplement, which is a proprietary blend of ketone mineral salts, puts your body into a state of therapeutic ketosis within 60 minutes of drinking it without having to be on a strict ketogenic diet.

Now, this ketone supplement is not an approved treatment by the FDA for treatment of AD or any other disease for that matter. However, I am so convinced, based on what the research suggests on what the Alzheimer’s brain needs to function at its optimal level. Along with what the potential benefits of being in the state of ketosis offers, including how it could work for the Alzheimer’s brain that I personally drink it myself and have also recommended it to my parents. Since there is no known cure for AD or proven treatment yet available, if something as simple as drinking this supplement twice a day would help with your memory would you give it a try?

Bibliography

Cunnane, S. C. (2016). Can ketones compensate for deteriorating brain glucose uptake during aging? Implications for the risk and treatment of Alzheimer’s disease. Annals of the New York Academy of Sciences, 1367, 12-20.

Cunnane, S. e. (2011). Brain fuel metabolism, aging and Alzheimer’s disease. Nutrition (27), 3-20.

Gano, L. B. (2014). Ketogenic diets, mitochondria, and neurological diseases. Journal of Lipid Research, 55, 2211-2228.

Gasior, M. e. (2006). Neuroprotective and disease modifying effects of the ketogenic diet. Behavoral Pharmacology (17), 431-439.

Hashim, S. W. (2014). Ketone body therapy: from the ketogenic diet to the oral administartion of ketone ester. Journal of Lipid Research, 55, 1818-1826.

Krikorian, R. E. (2012). Dietary ketosis enhances memory in mild cognitive impairment. Neurobiology of Aging, 425 (e19).

Newport, M. T. (2015). A new way to produce hyperketonemia: Use of ketone ester in a case of Alzheimer’s disease. Alzheimer’s & Dementia, 11, 99-103.

 

The medical information on this site is provided as an information resource only. This information does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment.
tip for healthy brain

Tips to keeping your brain healthy

8 ways to keep your brain healthy

As  Neurologist I am frequently asked, “what can I take to keep my brain healthy to help prevent Alzheimer’s dementia”.  My answer is that there is no simple pill to keep your brain healthy, but these 8 tips are a great place to start.

  1. Exercise your body: More and more studies are coming out which reinforces what I have long believed, that exercise is the best prescription I can give to prevent Alzheimer’s dementia.
  1. Exercise your brain: Your brain is the most powerful ‘muscle’ of all. If you don’t use it you will lose it!
  1. Keep blood sugars under control: Diabetes increases your risk for Alzheimer’s dementia, as does having high blood sugar levels, in general, even without diabetes.
  1. Consider changing your diet to low carbohydrate high fat diet: A ketogenic diet has been shown to improve brain function, (and it will decrease your risk for diabetes). If you are not ready for that significant of a change, at least start adding more healthier fats into your diet such as: olive oil, DHE, Omega 3 fatty acids and coconut oil.
  1. Keep hydrated, drink more water: You should be drinking half your body weight in ounces of water each day. Example: if you weigh 150 pounds, you should drink 75 ounces of water each day.
  1. Increase your daily intake of antioxidants: Antioxidants help protect your brain from damaging free radicals.  Some common antioxidants include Vitamin C and E along with selenium and flavonoids. The best sources of natural antioxidants are fruits and vegetables.
  1. Decrease stress: If you are unable to limit the amount of stress you have in your life, at least find a healthy way to deal with it. My personal favorite is exercise!
  1. Get more sleep:  Preferably between 7-8 hours per night.

 

fuel pump

Benefits of fueling your body with ketones

Why Ketones are a better fuel source than glucose

Where do our bodies get the energy to fuel our activities of daily living? 

Glucose is the main fuel source of our bodies, but there is another type of fuel that is available to our bodies, ketones.  Ketones are a natural by-product of fat metabolism.  When the body has run out of glucose to use as fuel it will switch fuel sources and start converting fat into fatty acids and then into ketones.  Our bodies were designed to use this duel source of energy based on how we lived in the caveman days.  In the summer and spring when food was plentiful, cavemen would eat more food and pack on the extra and store it as fat.  Then in the fall and winter when food was scarce, the cavemen would live off that extra stored fat.   Nowadays, since food supply is plentiful all year around and there is no physiological need or demand to live off the stored fat, thus we may just keep packing it on, all year around.

What are the differences between ketones and glucose as a source of energy?

Research suggests that ketones are a better, cleaner source of energy for the body and actually provide more energy than glucose.  Unlike glucose, ketones do not depend on insulin to get into the cells for use. Ketones produce less carbon dioxide and free radicals than when the body uses glucose as a fuel source thus are less toxic for our body, making it a cleaner fuel source. Unfortunately, ketones are harder energy source for our bodies to tap into since they require your body to be in either a starvation mode or at least be in a state of very low in carbohydrates.  Nowadays, the most common way of getting the body to produce ketones, or be in a state of ketosis, is by being on a very low carb diet i.e. a ketogenic diet.  Typically, a ketogenic diet consists of 5-10% carbohydrates, 20-25% protein and 65-75% fats.  As you can imagine this is not easy to achieve.

For those who do achieve ketosis, the benefits to the body and the brain are impressive.  Here are just a few of the benefits that are suggested by the research:

1) Better Brain Function

As a Neurologist this is the benefit of ketosis I have to list first.  If ketones are available, then they are the preferred fuel for the brain over glucose.  Subjectively, this means improved focus and mental cognition.  Objectively, it has been shown to improve memory in patients with Alzheimer’s dementia.  A ketogenic diet has been used for over 80 years in the treatment of difficult to control seizures.  It is also being studied in: Parkinson’s disease, ALS, traumatic brain injury, and hypoxic brain injury.  Ketosis has also been shown to be beneficial in patients with migraine headaches, ADD, PTSD and depression.

2) Better Athletic Performance

Forget carb loading, for better athletic performance.  Ketones are a better energy source for your workouts.  Ketones provides  more ATP (adenosine triphosphate) than glucose.  Subjectively, many people who achieve ketosis report feeling of increased energy levels.  Having more ATP means more energy to workout longer and harder. Objectively, several studies on endurance athletes have shown that athletes who are in ketosis are able to perform at a higher level for a longer period of time.

3) Fat Loss

When your body is in ketosis it is now literally a ‘fat burning machine’.  Without having carbohydrates/glucose around for energy, your body starts releasing stored fat, which then will be turned into ketones for energy. Thus, inches drop off faster than with a low-fat high carb diet because you are actively burning up your stored fat.  Additionally, high fat diet have a protein (muscle) sparing effect so if you are calorie restricted, your body will be protected against breakdown of skeletal muscle as a source of fuel.

4) Improved Diabetes

Diabetes is either due to a decreased insulin production (type 1 diabetes) or insulin resistance (type 2 diabetes). Insulin is required to transport glucose into the cells for use.   In type 1 diabetes, there is not enough insulin around for the amount of glucose in the body. In type 2 diabetes, the cells are ‘resistant’ to the insulin that is around, and the cells are not able to process the glucose. Since all carbohydrates we eat break down into glucose, treatment of diabetes is often focused around lowering the glucose level, thus eating a low carb diet is recommended. Studies in individuals with type 2 diabetes using either, a very low carbohydrate or a ketogenic diet have had impressive results. These studies have showed that the participants were able to decrease or completely withdrawal off of the use of insulin, along with having major weight loss in a matter of just a few weeks. Also, it has been reported that eating a high fat, ketogenic diet can also improve insulin sensitivity, meaning the insulin that is around works better.

5) Less Inflammation

One of the ketones produced by the body is beta-hydroxybutyrate, has been shown to have an anti-inflammatory effect. Reports show individuals eating a ketogenic diet have some symptomatic improvement from rheumatoid arthritis, polycystic ovary disease, migraine headaches, eczema, and other conditions caused by inflammatory processes.

If ketosis is so good for you then why isn’t everyone doing it?

Well, first of all, most mainstream nutritionists and the USDA still recommend carbohydrates as a main staple of our diet.  Second, we live in a world that is addicted to carbohydrates.  Thus, most people simply cannot adhere to the strict diet that is required to get into and stay in ketosis through nutritional adjustments of eating so few carbohydrates.

So what if there was a supplement of exogenous ketones that could put you in therapeutic ketosis within an hour, despite your diet, and allow you to potentially to tap into the above-mentioned benefits without having to be on a strict ketogenic diet?  Sounds too good to be true, doesn’t it?   Luckily, such a supplement was developed under US Department of Defense commissioned research for use in Navy Seal divers to prevent seizures that could occur in association with using high-oxygen re-breathers (oxygen toxicity).   A ketone supplement that was inspired based on that research and has been released for sale to the public.  If you would like more information about this new ketone supplement check it out.

If you would like some help starting a ketogenic diet I would be happy to help.

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Bibliography

Di Lorenzo, C. e. (2015). Migraine improvement during short lasting ketogenesis: a proof-of concept study. European Journal of Neurology (22), 170–177.
D’Agostino, D. P. (2013). Therapeutic ketosis with ketone ester delays central nervous system oxygen toxicity seizures in rats. American Journal of Physiology. Regulatory, Integrative and Comparative Physiology, 304, R829–R836.
Paoli, A. E. (2013). Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. European Journal of Clinical Nutrition (67), 789-796.
Stafstrom, C. R. (2012). The Ketogenic diet as a treatment paradigm for diverse neurological disorders. Frontiers in Pharmacology, 3, 1-8.
Youm, Y. (2015). Ketone body β-hydroxybutyrate blocks the NLRP3 inflammasome-mediated inflammatory disease. Nature Medicine, 21 (3), 263–269.
These statements have not been evaluated by the Food and Drug Administration. These products are not intended to are not intended to diagnose prevent treat or cure any disease.
The medical information on this site is provided as an information resource only. This information does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment.
headache-woman200

Migraine Triggers

What are migraine triggers and

Why do I have migraine headaches?

As a headache specialist I get asked this all the time.   Migraine unfortunately is all too common. The lasted estimates are that there are over 36 million people who suffer from migraines in the United States. Not only is it very common, but also migraine headaches are also very disabling. Migraine headaches are listed as the 4th leading cause of disability in women and the 7th leading cause overall.

The pathophysiology of migraine is not completely known. What is known is that some ‘triggers’ activate the neurons in the brain these neurons release neurochemical, CGRP, Substance P, and Kinins. These neurochemical then cause a localized neurogenic inflammation and localized vasodilation. If the trigger remains or if more neurons become activated eventually the abnormal electrical sign will propagate up into the cerebral cortex and you will start to feel the pain of a migraine.

If the conditions are just right, any one probably can have a migraine that is if they have enough ‘triggers’. However the people who suffer from regular migraine headaches have a genetically induced hypersensitive brain.   What does hypersensitivity mean? Basically the way I like to describe it is, that in these genetically predisposed individual it does not take as many of the triggers to trigger a migraine. Another way to think about it is that the migrainour’s brain does not like change, and any change in the external or internal environment may just be enough to trigger a migraine.

What are triggers?

Triggers can be either internal or external factors that can initiation the process of a migraine. Not everyone has the same triggers and the same triggers do not always ‘trigger’ a migraine. Here are some of the more common triggers reported.

  • Change in routine – the brain does not like change, so any change your regular routine can trigger migraine.
    • This includes changes in sleeping patterns. Both lack of sleep and too much sleep may be a trigger.
    • Skipping meals, or fasting
    • Changes in external environment temperatures – i.e. going from a hot outdoor temperature to a cold air-conditioned room.
    • Changes in hormones: Both around the time of their menstrual cycle and being premenopausal are often times that women are more prone to migraine headaches.
    • Changes in weather specifically; barometric pressure changes are often reported as times when migraines become more frequent.
  • Dehydration
  • Certain foods and additives
    • Red Wines
    • MSG
    • Artificial Sweeteners
    • Processed foods
  • Stress: but not only can stress it self trigger a migraine, but frequently people experience a migraine after a “let- down” of stress. So often see increase in migraines after school finals are over, or after that completely that big project at work.
  • Strong smells such as perfumes or certain scented cleaning products can trigger migraines in some people.

As you might notice not all the triggers are avoidable but I always encourage my patients to do the best that they can to get in a regular pattern/routine and do the best to stick to it. Then also eliminating the triggers that they can control. I also stress the importance of starting/continuing a regular exercise program. As discussed in prior blog post, this can also help prevent migraines.

Dr Deb

Pomegranate_Image-200

Got Antioxidants?

What are antioxidants and why you need them in your diet

Antioxidants are a needed to protect the body from molecules known as free radicals. Free radicals occur naturally in our bodies. There are also external factors that increase free radical production including: stress, the burning of sugars from an unhealthy diet, along with the break down of medications and toxins. Free radicals cause cell damage by oxidization (much the same way that oxygen in the air rusts exposed metal on a car). Oxidization of cells is common pathway to aging and development of a range of illnesses and diseases including cancers, and cardiovascular disease. Luckily antioxidants are around to neutralize these free radicals.

Unfortunately, our bodies do not have enough antioxidants to fight all the free radicals, thus we must make sure our diet includes them. To get enough antioxidants it is recommended that we eat 7-9 servings of fruits and vegetables a day. Not an easy thing to do for most people, but luckily I get my daily allotment in one glass of Shakeology. Shakeology has 12 different super foods which are considered to be antioxidants including: Cacao, Acerola Cherry, Pomegranate, Camu-Camu, Bilberry, Goji Berry, Blueberry, Açai, Green Tea, Rose Hips, Cinnamon, and Luo Han Guo.

The most powerful anti-oxidant of all fruits is the Pomegranate.

Punicalagin is a compound found only in pomegranates that is responsible for pomegranate’s antioxidant and health benefits. Some health benefits that have been reported from punicalagin include:

  • Lowering of blood pressure
  • Lowering of cholesterol
  • Inhibits abnormal platelet aggregation to help prevent strokes and heart attacks
  • Promotes the reversal of atherosclerotic plaques
  • Inhibit cancers including breast, prostate, colon and leukemia
  • Improves depression symptoms
  • Protects against osteoporosis

So instead of going to the doctor to get on medications to decrease your blood pressure, consider discussing with your doctor a trial of just drinking a glass of Shakeology on a daily basis. A glass a Shakeology a day may just be the thing to keep the doctor away!

get fit 4 your brain

This information is not intended to replace the advice of a doctor. Shakeology is not intended to diagnose, treat, cure, or prevent any disease or been evaluated by theFood and Drug Administration.

alz brain

Exercise prevents Alzheimer’s pathology

Exercise can prevent Alzheimer’s pathology in the brain

Age is considered the #1 risk factor for the development of Alzheimer’s Dementia (AD). The pathological changes in the brain of a patient with AD include abnormal beta–amyloid deposition in plaques and neurofibrillary tangles  resulting in neuronal loss and shrinkage of the brain. These changes, however, can be seen as early as 30 years before clinical symptoms occur but increase as we age.

As of yet there are not any drug or medical treatments that have been shown to prevent or reverse these changes in the brain of patients with AD. However, a recent study just published in the November 2014 issue of Neurology showed that exercise lessens these preclinical pathological biomarkers of AD.

Prior to this recent study, we had multiple studies that showed the following: (1) exercise can help to preserve memory as we age; (2) exercise has been shown to improve cognition in patients who already have Alzheimer’s and (3) exercise can improve brain volumes, most specifically, in the memory processing areas of the brain, the hippocampus. This is the first study that specifically looks at the pathological changes of AD resulting from exercise.

This study looked at late middle-aged adults (ages 40-65 at entry) who were cognitively normal but at high risk for AD. They investigated whether engagement in physical activity lessons age association alterations in beta-amyloid accumulation, cerebral glucose metabolism, hippocampal volume and cognitive function. Being physically active was based on the American Heart Association recommendation of 30 minute of moderate exercise 5 days a week.

The study found was that the physically active individuals had less beta-amyloid burden, improved glucose metabolism, hippocampal volume, immediate memory, and visuospatial ability compared to physically inactive persons.  This study provides more confirmatory support to the many other studies that show the beneficial effect of physical activity on the aging brain.

Since physical exercise has been shown to improve cognition, improve brain volumes and now decrease the age related disease markers of AD what are you waiting for? There is so much we do not have control over in our lives, but this is not one of them. You have the power to get and keep your brain fit and, potentially, prevent AD.  If you do not know where to start I would be happy to help find a program just for you.

 

Dr Deb

Works Cited:

Okonwo, O. e. (2014). Physical activity attenuates age-related biomarker alterations in preclinical AD. Neurology , 83, 1753-1760.

healthy-apple

A Healthy lifestyle can reduce YOUR risk of stroke

How you can decrease your risk of stroke

As a neurologist, I see on a daily basis how devastating and debilitating a stroke can be. Unfortunately, the effects are typically irreversible. Therefore, prevention is of great importance. Controllable risk factors for stroke include hypertension, diabetes, high cholesterol, and smoking.   Thus, living a healthy lifestyle, which potentially would improve those risk factors, could decrease your risk for stroke.

Researchers in a recent study analyzed the combined effect of five factors that typically are associated with living a healthy lifestyle to see if living a healthy lifestyle would indeed decrease the risk of stroke. The 5 factors studied and recommended for a healthy lifestyle include: having a healthy diet, i.e., eating within the top 50% of a recommended foods, modest alcohol consumption (not greater than 3-9 drinks per week), not smoking, 40 minutes of being physically active per day and BMI of <25 kg/m2

The study found that women who had all 5 factors of healthy lifestyle compared with women with none had a 62% lower risk of ischemic stroke. All 5 components of the low risk lifestyle were inversely associated with the risk of ischemic stroke. The risk of stroke steadily decreased with each additional healthy lifestyle factor.

Once again research documents the importance of exercise as a part of a healthy lifestyle AND prevention of a devastating stroke. If you wish to add exercise to decrease your risk of a stroke but don’t know where to start, I would love to help you.

 

Dr Deb

Works Cited

Larsson, S. C. (2014). Healthy diet and lifestyle and risk of stroke in a prospective cohort of women. Neurology , 83, 1699-1704.

 

inflammation-200

Inflammation And Your Brain

 What is INFLAMMATION and what it is doing to your Brain?

Inflammation is a vital process for the body.  The body uses inflammation to heal itself against something that it thinks is harmful.  You can recognize inflammation as the redness and swelling that occurs when you get a cut or sprain your ankle.  Inflammation also occurs internally when you are sick and the body needs to fight off the infection.  The problem occurs when the inflammation process is in excess to what is needed or becomes chronic meaning that it lasts for a longer time than it should.

It is easy to understand how chronic inflammation can be linked to conditions such as arthritis and autoimmune disorders since typically the treatment is an anti-inflammatory medication.  Chronic inflammation, however, is also linked to many chronic conditions that you might not think of including: coronary artery disease, stroke, cancer, diabetes, epilepsy, Alzheimer’s dementia, multiple sclerosis, along with chronic pain syndromes such as migraines and fibromyalgia.

Chronic inflammation is not just confined to a particular tissue but involves different organs in the body including the brain.  Some signs that you have inflammation in your body are obvious such as joint pain and redness.  The problem, however, is when inflammation occurs throughout your body, the signs of inflammation may not be as obvious. Your body can have chronic inflammation occurring and you don’t even realize it.  Some of the symptoms that have been associated with chronic inflammation include:  fatigue or lethargy, somnolence, brain fog, weakness, anxiety, depression, irritability and headaches.

Why does inflammation cause damage?  Inflammation is a complex biological reaction. Basically, when the body is injured, white blood cells, which are the body’s first responders to a problem, are recruited to the site of damage.  They release chemicals, which are pro-inflammatory including histamines, cytokines (interleuking-6, interleukin-1B and tumor necrosis factor), prostaglandins, and leukotrienes.  These chemicals then cause an activation of pathways that leads to increased free radical production.  When there is an increased free radical production with decreased levels of antioxidants, it leads to oxidation stress.  Oxidative stress causes damage to the cells and proteins.  This damage causes more inflammation, which causes more free radicals and the cycle continues.  Since oxidative tissues and cells do not function normally, this leads to organ dysfunction and chronic health problems.

Causes of Inflammation

  1. Stress
  2. Trauma/injury
  3. Infections
  4. Pollution/toxins such as tobacco smoke
  5. Chemicals including some drugs and artificial sweeteners
  6. Obesity and adipose tissue (especially central fat)
  7. Food allergies and sensitivities (gluten, soy, nuts, shellfish, dairy, egg)
  8. Processed grains and refined carbs i.e. carbohydrates with relatively high glycemic index
  9. Trans-fatty acids and omega 6 polyunsaturated fatty acids that are found in many vegetable oils

So what can we do to prevent or decrease inflammation?

First is to remove any of the things listed above that can be a contribution to inflammation.   This includes removing processed foods, artificial sweeteners, vegetable oils, high GI carbs along with any food from your diet to which that you are sensitive.   You should also commit to decreasing stress, stop smoking and losing weight (decreasing body fat).

There are foods that have been reported to have natural anti-inflammatory properties including:

  1. Spices Turmeric, Garlic, Cayenne, Cinnamon and Ginger
  2. Foods that are high in fiber such as fruits and vegetables
  3. Food that are high in Omega 3 such as salmon, anchovies, flax seed, walnuts, chia seed and sachi inchi
  4. Food that is high in magnesium including dark greens and quinoa (for other good sources of magnesium click here)
  5. Super foods such as Ashwagandha, reishi mushroom, and holy basil

Ketones or Ketone bodies, specifically B- hydroxybutyrate, have been shown to decrease inflammation in your body.  Ketones including B- hydroxybutyrate are a naturally occurring by-product of burning fat when the body is low in carbohydrates or proteins. Ketosis or the production of ketone bodies occurs if you eat a very low carbohydrate diet such as the ketogenic diet or during times of starvation.   Up until recently this was the only way to feel the benefits of ketones, an alternative fuel source for the body.  Just in the last year a supplement became available that contains the ketone body, B- hydroxybutyrate.  When the supplement is taken, it will put your body into a state of ketosis in just 60 minutes, no matter how many carbohydrates you have eaten.

Exercise is also a great way to decrease inflammation. Exercise can  decrease stress and obesity which then can decrease inflammation.  Additionally, exercise directly lowers inflammatory cytokines. Population studies have shown that people who preform more frequent physical activity have lower levels of inflammatory cytokines, even after adjusting for obesity (BMI).  Lastly, there is also positive data from randomized controlled trials showing that increasing aerobic physical activity is effective in decreasing chronic inflammation.

In summary, if we don’t want inflammation and all the consequences of inflammation, we have to be more committed to more healthy living.  Including watching what we eat and what we should not eat, along with starting a regular exercise program. You and your brain deserve it.

inflammation

Bibliography

Beavers, K. M. (2010). Effect of exercise training on chronic inflammation. Clinica Chimica Acta , 411, 785-793.

Gabay, C. M. (1999). Acute-Phase Proteins and other Systemic Responses to Inflammation. New England Journal of Medicine , 340 (6), 448-454.

Galland, L. M. (2010). Diet and Inflammation. Nutrition in Clinical Practice , 35 (6), 634-640.

Hunt, K. J. (2010). Inflammation in Aging Part 1: Physiology and Immunological Mechanisms. Biological Research for Nursing , 11 (3), 245-252.

Lucas, S.-M. e. (2006). The role of inflammation in CNS injury and disease. British Journal of Pharmacology , 147, S232-240.

Morgillo, F. e. (2007). Chronic inflammation and oxidative stress in human carcinogensis. Internation Journal of Cancer , 121 (11), 2381-2386.

Youm, Yun-Hee. (2015). Ketone body β-hydroxybutyrate blocks the NLRP3 inflammasome-mediated inflammatory disease. Nature Medicine, 21 (3), 263-269.

This site is purely informative and should not be considered medical advice. It is not intended to be used to diagnosis or treat any disease.  Please consult your physician before starting any fitness program or new supplement.

sweeteners

Non-Caloric Sweeteners

Non-Caloric Sweeteners,

Friend or Foe?

sweeteners

More and more people have turned to non-caloric sweeteners, in attempts to lose weight or at least, help prevent further weight gains. Questions have been raised about whether or not we are, instead, doing our bodies a disservice?

1.  Can non-caloric sweeteners cause weight gain?

Counterintuitive to what we might think, there is evidence that the use of non-caloric sweeteners may actually be associated with weight gain.  This was first shown in the San Antonio Heart Study. This study-documented weight changes over a 7-8 year period in people who drank beverages sweetened with non-caloric sweeteners compared to those who did not.  They found that those who drank on average 21 beverages sweetened with non-caloric sweeteners per week had about double the risk of being obese.  This was true regardless of the weight of the person at the start of the study.

Another study published in the January 2013 issue of the journal Appetite, found similar findings in rats. In this12 week study rats were fed plain yogurt sweetened with aspartame, saccharin, or sugar in addition to their regular rat chow.  What they found was that the rats that were given either saccharin or aspartame in their yogurt had an increased weight gain compared to rats that were given only sucrose in their yogurt.

2.  Can non-caloric sweeteners increase you risk for type 2 diabetes?

There have been multiple studies that have shown that the consumption of beverages sweetened with non-caloric sweeteners increased the risk for type 2 diabetes compared to non-consumers of beverages sweetened with non-caloric sweeteners.  This was seen even in participants who were of normal weight at baseline.

3.  Can non-caloric sweeteners cause an increase your appetite?

It is unclear why non-caloric sweeteners would cause weight gain and/or increase your risk for diabetes.  One of the theories is that non-caloric sweeteners are felt to increase your appetite.  Experiments have found that the sweet taste, regardless of its caloric content, increases your appetite.  Real sugar tells your brain that it has received enough calories, thus activating satiety signaling and telling your body that you are full.  Non-caloric sweeteners stimulate your appetite by the sweet taste, but your body keeps waiting for the calories to come. When the calories do not come, the sensations of hunger remain.

4.  Are non-caloric sweeteners associated with any side effects?

a. Sucralose (Splenda): has been shown to trigger migraine headaches. It has also showed to increase the incidence of inflammatory bowel diseases possibly due to the decrease in the amount of beneficial gut bacteria as the result of Sucralose consumption.

b.  Saccharin (Sweet’N Low):  has been reported to cause cancers at very high doses.  Between the years 1981 and 2000 the FDA required labeling to warn about possible carcinogenic effects.  Those warnings have since been removed.

c.  Aspartame (NutraSweet and Equal): has possible side effects including dizziness, headaches, GI issues and mood changes.

Aspartame is broken down into phenylalanine (50%), aspartic acid (40%) and methanol (10%) in the body. The excess of phenylalanine from the breakdown of aspartame blocks the transport of important amino acids in the brain contributing to reduced levels of dopamine and serotonin.  Aspartic acid is the precursor to an excitatory amino acid glutamate.  Increased amounts of this and other excitatory amino acids results in increased free radical formations, increased oxidative stress and increased inflammation in the brain. This results in cell death.  These alterations seen are similar to those occurring in neurodegenerative diseases such as Alzheimer’s disease.  Increased inflammation also linked to diseases such as fibromyalgia and other chronic pain syndromes.

It has also been reported that, if stored too long in high temperatures and in a pH above 6, aspartame produces a carcinogenic metabolite – diketopiperazine.  This breakdown product has been reported to cause tumors in the brain including gliomas, medulloblastomas, and meningiomas.

5.  Do ALL non-caloric sweeteners have potential side effects?

Stevia is a natural non-caloric sweetener that is isolated from the plant Stevia Rebaudiana Bertoni.  So far no negative side effects have been reported with its use. Additionally, a study has found that participants who consumed products made with Stevia had lower total caloric intake compared to those consuming sucrose.  Consumption of stevia also lowered postprandial insulin and glucose levels compared to consumption of aspartame and sucrose.

The FDA and most industry-funded studies endorse the safety of these additives. I however have formed my opinion based on these and other studies that I have read.  Based on these studies I have come to the realization that non-caloric sweeteners may not be the best things to be putting into our bodies but if I were going to reach for one maybe a better alternative would be Stevia.

Bibliography

Anton, S. E. (2010). Effects of stevia, aspartame, and sucrose on food intake, satiety, and postprandial glucose and insulin levels. Appetite , 55, 37-43.

Fowler, S. P. (2008). Fueling the Obesity Epidemic? Artificially Sweetened Beverage Use and Long-tem Weight Gain. Obesity , 16 (8), 1894-1900.

Rycerz, K. e. (2013). Effects of aspartame metabolites on astrocytes and neurons. Folia Neuropathologica , 51 (1), 10-17.

Shankar, P. P. (2013). Non-nutritive sweeteners: Review and update. Nutrition , 29, 1293-1299.

Swithers, S. (2013). Artifical sweeteners produce the counterintuitive effect of inducing metabolic derangements. Trends in Endocrinology and Metabolism , 24 (9), 431-441.

FYI-migraine

5 Things You Should Question About Your Migraines

 5 Things you should question your Doctor about your Migraines

Here are 5 things that American Headache Society task force recommends to help physicians and patients make wise decisions about the most appropriate migraine care.

1.  There is no need to preform neuroimaging studies when you have stable migraine headaches.  This is based on the fact that there is numerous evidence-based guidelines have shown that the risk of intracranial disease is not elevated in people with migraine headaches.   A migraine diagnoses however needs to be made based on the International Classification of Headache Disorders criteria to avoid missing patients with more serious headache.

2. If you are going to get neuroimaging, make sure you get a MRI instead of CT scan, except in emergency setting.  A MRI is more sensitive than CT scan for the detection of many of the secondary causes of headache.  CT scan should only be obtained in the emergency setting when hemorrhage or acute stroke is suspected.

3.  Do not get surgical deactivation of migraine trigger points outside of a clinical trial.  The value of the form of ‘migraine surgery’ is still under question with limit evidence that it is effective or safe.  Long term side effects from these types of procedures are also unknown.
4.  Do not take opioids or butalbital containing medications as first line treatment for your migraines.  These medications  can impair alertness,  produce dependence or addiction.  They may worsen your headaches by increasing the frequency of your headaches and may make your headaches harder to treat.  These medications may also produce heightened sensitivity to pain.
 

5.  Do not use prolonged or frequent use of over the counter medication for your migraines.  Over the counter medications (OTC) can be used for occasional headaches if they work reliably without side effects.   Frequent use (especially of the caffeine containing medications) can lead to an increase in headache frequency/medication overuse headaches.   Overuse of Acetaminophen containing medications can cause liver damage.   Overuse of non-steroidal anti-inflammatory drugs can lead to gastrointestinal bleeding.  Thus it is recommended that you do not take OTC more than 2 days a week.

 

Reference:

Loder E, Weizenbaum E, Frischberg B, Siberstein S.  Choosing Wisely in Headache Medicine: The American Headache Society’s List of Five Things Physicians and Patients Should Question. Headache. 2013:53:1651-1659.

Moran, M. From the American Headache Society: ‘Choosing Wisely’ in Headache Medicine: The American Headache Society’s List of Five Things Physicians and Patients Should Question about Migraine. Neurology Today. 2014:14.