A Memorable Discovery for Dementia?

Having recently celebrated my 30^th anniversary at the University of Maryland School of Medicine and upon hearing the Beatle’s tune, “In My Life”, I was struck by the verse “and these memories lose their meaning”.  Though highly unlikely that John (Lennon) wrote this verse with “dementia” in mind, the words can certainly be consistent with memory loss.

Yet while tremendous strides have unfolded in treating cardiovascular disease (heart attacks, strokes, etc) in recent decades, the pace of progress has been slower when it comes to prevention/treatment of Alzheimer’s disease and other forms of dementia.  The initial exhuberance following FDA’s approval of Biogen’s Alzheimer’s disease drug, (aducanumab or  “Aduhelm”) last month, despite mixed study results, was met with immediate skepticism and calls for a federal investigation as to whether there was sufficient justification to warrant approval.   Undoubtedly, stakes are high with an estimated 6.2 million Americans (~1 in 9) aged 65 and older having some form of dementia.

However, hope may be on the horizon as a new study out this week sheds important insights into how memory loss may be reversed.  The study conducted in the United Kingdom examined PNNs (perineuronal nets), highly specialized structures involved in regulating neuroplasticity (the way the adaptive brain learns and develops new memories).  In early childhood, there is increased neuroplasticity but as the brain ages, PNNs decrease and neuroplasticity wanes. An important compound in PNNs that promotes neuroplasticity is chondroitin-6-sulfate (C6S).  The new study found that administration of C6S to aged mice restored their ability to quickly recognize objects at levels similarly observed in younger mice.

Bottom Line: while more animal studies are required to confirm the effects of C6S on memory before progressing to human trials, the new study may turn out to be a memorable discovery for dementia.

In the meantime, listed below are lifestyle related tools that may help sharpen your memory:

1. Reduce Sugary Beverages: Drinking more than 1 sugared beverage (soda, juice) daily was associated with reduced memory and lower brain volume compared to minimal or no sugary beverage intake.
2. Add Blueberries: 1 cup of fresh blueberries daily is associated with fewer learning errors and improved cognition in men and women aged 60 years and older.
3. Practice Mind–Body Exercises: Participating in mind-body exercises such as Tai Chi, yoga and dancing mindfulness movements improve learning, memory and adaptable brain responses (neuroplasticity). 
4. Aerobic Activity: Moderate aerobic activity (walking at a pace of 3-5 mph) was shown to improve cerebral blood flow and cognitive function in men and women with mild cognitive impairment over a 12-month period.
5. Sneak in an Afternoon Nap: Power napping for as little as 30 minutes in the afternoon is associated with improved memory and cognitive function.
6. Stay Hydrated: Dehydration is associated with impaired cognitive function. Drinking  6 ounces of water each hour over a 10 hour period will help keep your mind sharp.

Dr. Michael Miller is Professor of Medicine at the University of Maryland School of Medicine.

EPA versus EPA/DHA: What Have Clinical Trials Taught Us?

Our new review paper out this week entitled “A Fishy Topic: VITAL, REDUCE-IT, STRENGTH and Beyond; Putting Omega-3 Fatty Acids into Practice in 2021” was designed to reduce the confusion surrounding the use of the marine derived omega 3 fatty acids, EPA (eiscosapentanoic acid) and DHA (docosahexanoic acid).  Coincidentally, this paper compliments last week’s publication in the Lancet journal, EClinical Medicine entitled, “Effect of omega-3 fatty acids on cardiovascular outcomes: A systematic review and meta-analysis” led by my colleagues,  Drs. Safi Khan and Deepak Bhatt and showing that EPA but not the combination of EPA+DHA was associated with reduced risk of cardiovascular events such as heart attacks, strokes and heart related death (see Figure).

As both EPA and DHA are extracted from oily fish including salmon, sardines, anchovies and herring and both lower triglycerides to a similar degree, why have clinical trials using EPA compared to EPA+DHA shown contrasting results?   Elegant work from Dr. Preston Mason and his co-workers have provided important insights at the cellular level demonstrating that EPA possesses cardioprotective anti-inflammatory, anti-oxidant, endothelial normalizing and membrane stabilizing properties that become suppressed in the presence of DHA.  Thus while DHA plays a pivotal role in brain growth and development, clinical trials to date have not borne out similar benefits with respect to cardioprotection.

I’ve been intrigued with EPA for more that a quarter century after we first observed dramatic differences in the way EPA was processed into cellular lipids when compared to prototypic saturated and monounsaturated fatty acids.   As differences between EPA, DHA and other fatty acids continue to emerge, listed below are a series of highlights related to the intake of these fats whether as a supplement or in medicinal form.

1. Dietary supplements such as “fish oil” capsules are NOT regulated by the FDA and should not be viewed in the same context as OTC products (such as Advil) that are regulated.
2. Fish oil capsules, a dietary supplement not regulated by the FDA, has been shown to contain a number of impurities such as saturated fat and oxidized lipids that impair its effectiveness.
3. EPA but not DHA exhibits heart protective antioxidant, anti-inflammatory and membrane/plaque stabilizing properties that help to reduce the risk of cardiovascular disease.
4. In the MESA study, higher blood levels of OM3 (inclusive of EPA) were associated with reduced risk of hospitalization for bleeding events.
5. In the REDUCE-IT USA study, 4 grams of Icosapent ethyl, the prescription form of highly purified EPA, was associated with a 30% reduction of death from all causes.
6. In the REDUCE-IT trial, total primary events (cardiovascular death, heart attack stroke, stent placement, bypass surgery or hospitalization for unstable angina) were reduced by 30%.

Dr. Michael Miller is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore,MD.  He is a Scientific Advisor for Amarin, Corp. and Steering Committee Member of the REDUCE-IT trial.  Dr. Miller is also the author of several books; including his most recent,  “Heal Your Heart…“

Lift Weights to Lose Weight

 

A new study shows that lifting weights/resistance training 2 or more days a week for as little as 30 minutes per session is associated with or a 20-30% lower risk of developing obesity over a 6 year period. In addition to traditional weight machines and free weights, muscle strengthening/tone activities include full body squats, pushups, planks and other core exercises.

This study adds to the growing evidence that muscle toning exercises are cardioprotective.  Among the first studies to demonstrate heart protection was the “Harvard Health Professionals’ Follow-Up Study, which found that weight training for at least 30 minutes each week resulted in a 23% lower risk of a heart attack or death from heart disease”**

Shown below are several other reasons why weight/resistance training aimed at muscle toning should be part of your overall physical fitness prescription to improve cardiometabolic health by reducing the following:

1. Type 2 diabetes: A study of nearly 4700 adults found that moderate weight training that resulted in increases in muscle mass (assessed by bench and leg press) reduced the risk of developing Type 2 diabetes by 32% over an 8-year period.
2. Conversion from Pre-diabetes to Type 2 diabetes: Another study of men and women with prediabetes (fasting glucose between 100-125 mg/dL) found resistance training (1 hour thrice weekly) to reduce conversion to Type 2 diabetes by 65%!
3. High Cholesterol: A Study of more than 7300 men found that ~1 hour of resistance training per week was associated with a 32% lower risk of high cholesterol (equal to or greater than 240 mg/dL) over ~20 years of followup.
4. Quitting Smoking: A study funded by the National Cancer Institute found that men and women who engaged in two 1-hour sessions of resistance training over a 12-week smoking cessation program were 2x as likely to successfully quit than their non- weight lifting counterparts.

Dr. Michael Miller is Director, Center for Preventive Cardiology at the University of Maryland Medical Center in Baltimore.

**from “Heal Your Heart: The Positive Emotions Prescription to Prevent and Reverse Heart Disease”

Reel in Your Migraines with “Brain Food”

As kids, many of us were told to eat our fish because it was “brain food”. Evolutionarily speaking, expansion of early human (hominid) brains occurred with consumption of aquatic animals (turtles, crocodiles) with further brain maturation/development accelerating as Homo sapiens migrated to coastal regions.  Now, in addition to serving as brain food, a new study suggests that consuming fish may also relieve migraine headaches.

The study, supported by the National Institutes of Health and published in the British Medical Journal, found that a diet enriched with omega-3 fatty acids (predominantly fish and shellfish) and low in linoleic acid (as derived from vegetable oils) reduced the frequency and intensity of migraine headaches by ~1/3 over the 4-month study period.  Potential mechanisms for these benefits include anti-inflammatory and pain-relieving properties from compounds (oxylipids) released by the omega-3’s, EPA and DHA coupled with pro-inflammatory properties associated with linoleic acid.

Bottom Line: if you have a history of migraines, try enriching your diet with omega-3 containing fish (e.g., salmon, sardines, herring) while reducing products high in linoleic acid (e.g., sunflower, corn, hempseed oil).

Listed below are additional health benefits attained through fish consumption.

1. An Australian study found that men and women aged 50 and older who consumed 2 or more fish meals each week experienced  a 40% lower likelihood of hearing loss over the 5-7 year follow-up period.
2. Parvalbumin, a protein enriched in carp, cod, herring and redfish has been shown to prevent the buildup of proteins associated with Parkinson’s disease.
3. A study from the United Kingdom found that addition of 6 ounces of fatty fish daily (salmon, sardines, kipper and herring) for 6 weeks was associated with improvement in long-standing psoriasis.
4. A Norwegian study found that fish consumption at least once weekly was associated with a lower risk of the Metabolic Syndrome.
5. A Swedish study in school children found that fish eaten at least once a week was associated with greater academic achievement than no fish consumption.

For other posts on this topic check out:

https://wp.me/p6flfR-152 and https://wp.me/p6flfR-14Q

Dr. Michael Miller, is Professor of Medicine at the University of Maryland School of Medicine in Baltimore, and author of several books, including his most recent “Heal Your Heart“.