Does a High Fat Diet Promote Memory Loss and Cognitive Decline?

A new study out this week and published in iScience found that fat cells play a major role in advancing brain aging and cognitive decline through Na,K+ATPase signaling.  Recent studies have suggested that this pathway is also responsible for conditions that accelerate cardiovascular disease risk including, metabolic syndrome and fatty liver (nonalcoholic steatohepatitis).

The new study was conducted in mice that were genetically modified to release the peptide, NaKtide, in fat cells.  NaKtide is a direct inhibitor of Na,K+ATPase signaling.  The authors found that compared to a control diet, a Western diet (greater than 40% of calories derived from fat) resulted in Na,K+ATPase -mediated cellular inflammation and altered levels of brain biomarkers that affect memory and cognition. These proinflammatory effects were abolished when NaKtide was activated, thereby resulting in improved function of regions that include the brain’s memory center (hippocampus).

The bottom line is that in a mouse model, Na,K+ATPase signaling in fat cells promotes memory loss and neurodegenerative changes.  They raise the possibility that a similarly operative signaling -pathway in humans might lead to adverse long-term neurologic consequences under certain conditions (such as repeated exposure to a high fat diet).  Finally, they suggest that effective therapies directed against this proinflammatory signaling pathway could offset cognitive decline.

Of course, the most effective and currently available approach to reduce cognitive decline as related to this pathway would consist of reducing daily intake of highly saturated, processed and deep-fried foods!

Listed below are additional features related to diet, physical activity, obesity and brain health.

1. Obesity promotes inflammation within the brain leading to cognitive decline and progression of neurodegenerative disorders.
2. Significant and rapid weight loss as a consequence of bariatric surgery has been associated with improvements in cognitive function including memory and executive function.
3. Adherence to the Mediterranean diet – high in vegetables, whole grains, fish, and olive oil – correlates with higher cognitive function.
4. Compared to a high fat, Atkins Diet, a low fat Ornish Diet is associated with low levels of TMAO, a gut metabolite predictive of increased cardiovascular disease risk and reduced cognitive function.
5. Replacement of saturated fat by polyunsaturated or monounsaturated fat is associated with lower rates of neurodegenerative disease.
6. Higher levels of physical activity are associated with a 35% reduced risk of cognitive decline and 14% reduced risk of dementia.
7. A diet containing at least one serving of green leafy vegetables each day is associated with slower age-related cognitive decline by approximately 10 years.
8. Metabolic Syndrome is associated with increased risk of developing cognitive impairment and premature dementia.
9. Chronic exposure to stress confers a higher risk of developing neurodegenerative disorders including Alzheimer’s disease.
10. Chronic insomnia is associated with a 30-35% increased risk of progressive dementia.
11. Musicians are 64% less likely to develop mild cognitive impairment or dementia, even after adjusting for physical activity and education.
12. Drinking 3-5 cups of coffee per day at midlife was associated with a decreased risk of dementia and Alzheimer’s Disease by about 65% at late-life.
13. Speaking at least 2 languages has been shown to delay the onset of dementia by 4-5 years.

Dr. Michael Miller is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland.  Check him out on twitter: @mmillermd1

“Go with your Gut”: Unlocking Secrets of Centenarians

Despite the ravages bestowed by COVID-19, more than 500,000 men and women worldwide have attained centenarian status (living to 100 years and beyond), including nearly 100,000 residing in the U.S.  Among this special group was my beloved father-in-law, Paul Miller, who taught math for 80 years and lived to the ripe young age of 104!

Many of us both inside/outside the medical profession find these individuals to be awe inspiring especially when they are still in relatively good physical and mental health upon reaching this major milestone. While we appreciate that exceptional longevity may be more heavily concentrated in a “Blue Zone“, the overwhelming majority of centenarians do not live in these regions.  In fact, there are nearly 2,000 centenarians living in the great (though non-Blue Zone U.S.) state of Maryland!

Now a new study published in the prestigious journal, Nature, is assisting scientific efforts toward unlocking secrets for healthy aging and longevity.  The study conducted in Japan, found that centenarians had high levels of protective gut byproducts.  Also known as isoalloLCA, these secondary bile acids, contribute to gut health by inhibiting gut bacteria that promote inflammation and disease (such as C. difficile). While a cause-effect relationship between protective gut byproducts and longevity has yet to be established, this study is an important step in furthering our understanding of the relationship between gut and overall health.

Listed below are other secrets to enhance the likelihood of healthy longevity.

1. Keep Saturated Animal Fats at Bay:  A study that we conducted with Dr. Stan Hazen and colleagues at the Cleveland Clinic found that a low fat Ornish diet was associated with reduced levels of the gut byproduct TMAO compared to a high saturated fat Atkins diet.  High levels of TMAO are associated with an increased risk of heart disease.
2. Think Positively about Aging: A study from the Yale School of Public Health found that older men and women who were genetic carriers of a gene that promotes dementia (APOE4 variant) were 50% less likely to develop dementia if they felt positively about the aging process.
3. Be Resilient: In a study of centenarians from Georgia and Japan, personality traits included a high degree of resiliency as characterized by high levels of openness and extraversion and low levels of hostility and neuroticism.
4. Have a Sense of Humor:Jeanne Louise Calment, the world’s oldest woman who died at age 122, credited her sense of humor for successful aging. In fact, a 15-year study from Norway found that women with a strong sense of humor experienced a nearly 50% higher survival rate compared to those lacking a sense of humor even with pre-existing heart disease or other chronic ailments.
5. Engage in Mentally Stimulating Activities: A Mayo clinic study found that participating in 3 mentally stimulating activities such as reading books, craft activities (e.g., quilting, or sewing) or playing card games/doing crossword puzzles ~age 70 was associated with a 45% reduction in cognitive decline over the subsequent 5 years.
6. Volunteer: Volunteering, especially over age 60 is associated with meaningfully positive effects on health and overall well-being.

Dr. Michael Miller is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland.  Check out his updated author page on Amazon.

 

 

 

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.

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“.

Are the Benefits of Omega 3’s Outweighed by Potential Side Effects?

In last week’s post, I highlighted differences between two omega 3 preparations, 1) purified EPA (Icosapent ethyl) and 2) combination of EPA/DHA as it relates to the risk of heart disease.

This past week we published a new study that examines the association between blood levels of omega 3 -fatty acids and the risk of major side effects (bleeding and atrial fibrillation).   Led by my colleagues Drs. Karan Kapoor and Michael Blaha, the study was designed to determine the extent to which these side effects might occur in participants of MESA (Multi-Ethnic Study of Atherosclerosis), a national study of men and women being monitored for the development of heart related events over a multi-year period.

Decades earlier, Danish physicians Jørn Dyerberg and Hans O. Bang reported that heart disease was rare but bleeding risk increased among Greenlandic Eskimos that they proposed was due to their high consumption of EPA from whale blubber, herring and other omega-3 enriched fish. These studies gained worldwide attention and laid the foundation for the hypothesis that omega-3 supplementation intake might reduce the risk of heart disease.

As an aside, I had the opportunity to meet Dr. Dyerberg when I presented some of our earlier work on triglycerides and heart disease at the International Society for the Study of Fatty Acids and Lipids in Lyon, France in 1998.

And although an increased risk of abnormal heart rhythms was not reported in Greenlandic Eskimos, two recent clinical trials that used high doses of purified EPA (REDUCE IT) or the combination of EPA/DHA (STRENGTH) identified an increased risk of atrial fibrillation.

Back to our study, not only was there a significantly lower (rather than higher) risk of major bleeding in men and women participants from MESA, but also the risk of atrial fibrillation was not increased.

Bottom Line: Adding omega 3 containing fish to your diet in place of saturated animal fat, is heart healthy- based on our current study it is also safe from major bleeding complications and atrial fibrillation. Purified EPA (Icosapent ethyl) as used in the REDUCE-IT study lowered the risk of cardiovascular events. Even though atrial fibrillation was slightly increased in REDUCE-IT, stroke rates-a primary complication of afib- were decreased.

Below are additional reasons why adding omega-3’s to your diet may improve overall health.

1. We recently found supplementation with Icosapent ethyl to maintain bone mineral health in men and women with the Metabolic Syndrome.
2. For each 1 serving per week increase in fish consumption, there is an approximate 7% lower risk of Alzheimer’s disease.
3. Eating salmon 3x weekly may lower blood pressure by 3-5 mmHg.
4. Consumption of fatty fish improves tear production and symptoms related to dry eyes.
5. Adding 1.5 grams of omega-3 fatty acids daily is associated with reduced mental stress and anxiety.
6. High blood levels of omega-3 fatty acids is associated with a trend towards reduced death from COVID-19.
7. In men and women with heart failure, the addition of 1 gram of omega-3 fatty acids may reduce the risk of re-hospitalization for heart failure.

Michael Miller, MD is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland and author of  “Heal Your Heart….”: published by Penguin Random House.  He served on the International Steering Committee for the REDUCE-IT trial.

The New Sleep Study that is Outrightly Nightmarish

Upon awakening (and before your caffeine fix), if you can say the title of this post three times perfectly in less than 10 seconds (go ahead, give it a shot…), odds are that you just slept like a baby!

In all seriousness, I was taken aback upon reading the newly published study that found men and women aged 50 and over who (on average), slept just 6 hours (or less) per night saw an  increased risk of dementia by 30% compared to those whose average sleep duration was at least 7 hours.    Other studies showed similar findings though most were conducted over a shorter follow-up period (generally less than 10 years).

We still don’t know whether sleep deprivation that begins at an earlier age has a similar effect.  Suffice it to say that during our medical or surgical residency training, we were chronically tired having been subjected to 36 hour shifts every 3^rd or 4^th night over multiple years.  Fortunately, today’s trainees are not afforded the rigorous sleep deprivation of previous generations.  As a result, the amount of time during medical training where 6 or fewer hours of sleep occurs is a lot lower than in years past.  Still, physicians are commonly assigned on-call overnight shifts where fewer than 6 hours slept has been the rule rather than exception.  Mechanisms proposed to account for the relationship between poor sleep and dementia include inflammation of the brain with buildup of cholesterol plaques in the lining of brain vessels as well as impaired processing of proteins (such as beta amyloid).

For my patients who have difficulty getting a good 7-8 hours of restful sleep not due to a medical condition (such as sleep apnea), I make the following recommendations.

1. Try to complete your dinner meal 4 hours prior to bedtime because a large part of digestion occurs during this period. Going to bed after a large meal is not conducive to a good night’s sleep if your body has to work overtime.
2. Take a 20-30 minute walk after dinner. Physical activity not only helps in digesting sugars and fat but also enables a more restful sleep.
3. Turn off the TV (or other stimulating activities) 1-2 hours before bedtime.
4. Try a cup of valerian tea or 2-4 ounces of tart cherry juice 1 hour before bedtime.
5. Engage in a relaxation activity (restorative yoga, meditation, lavender bath) 30 min-1 hour before bedtime.

Check out my heart health tips each day on twitter (https://twitter.com/mmillermd1) or Facebook: (healyourheartbook).

Michael Miller, MD is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland.

Emotional Rescue: The Heart-Brain Connection

Listed below is an excerpt from an article I wrote in the current issue of Cerebrum, published by the Dana Foundation on ways to reduce day-to-day stress and live a longer, healthier life.  If you want to read the entire piece, click here.

A special thanks to Bill Glovin for excellent editing and guidance in composing this piece.

Does counteracting negative stressors reduce cardiovascular risk? While no clinical outcome trials have been conducted to date, adoption of lifestyle strategies aimed at improving positive emotions seems to improve biomarkers of cardiovascular health, such as inflammation, arterial stiffness, and endothelial function. In my cardiology practice and as elaborated upon below, I recommend that my patients employ these five strategies to reduce day-to-day stressors:

1. Meditation (serotonin activated relaxation practices)

2. Yoga (GABA induced mood stabilization)

3. Laughter (endorphin mediated visual effects)

4. Music (dopamine regulated auditory effects)

5. Massages, hugging (oxytocin activated tactile responses)

Michael Miller, MD is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland  and author of “Heal Your Heart: The Positive Emotions Prescription to Prevent & Reverse Heart Disease” published by Penguin Random House.

5 Fall Foods to Brighten Your Mood

This past February I wrote about 5 foods to brighten one’s mood during the dead of winter! Now as we head into the colorful fall season, I thought it would be similarly appropriate to present fall foods that uplift your health, mood and spirits.

Here are 5 of my favorites:

1. Pumpkin Seeds:  As a rich source of magnesium, tryptophan and zinc, 1  handful each day is a superb snack to help calm daily stressors and elevate your mood.
2. Butternut Squash: Try 1/2 cup servings at least once weekly for a rich supply of heart healthy and mood boosting minerals and vitamins; they include potassium, manganese, vitamins A, E and B6.
3. Parsnips: A less colorful cousin of the carrot, parsnips are low in calories, high in fiber, manganese and the mood boosting vitamin folate. Parsnips are delicious in soups or as a side dish, especially when combined with carrots. Try steaming or roasting 1/2 cup (approximately 2 medium parsnips) at least once a week during the upcoming months as part of a savory autumn meal.
4. Sweet Potatoes: Ranked as the #1 food source of vitamin A, sweet potatoes are loaded with antioxidants, folate and vitamin B6.  Enjoy at least 1 sweet potato each week (and raise your spirits) during the fall season .
5. Cranberries:  Cranberries are also rich in antioxidants as well as the brain protective and anti-inflammatory compound ursolic acid.  Ursolic acid not only reduces growth of certain tumors but has also been shown to improve memory and reduce mood disorders, notably anxiety and depression.  Try a handful of fresh or dried cranberries at least once each week and reap the benefits!                                   Michael Miller, MD is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore, Maryland USA.  His latest book is  “Heal Your Heart: The Positive Emotions Prescription to Prevent & Reverse Heart Disease“.

5 Natural Ways to Boost Brainpower

With last weeks discovery of a potentially new blockbuster drug that may be the most effective to date to slow progression of Alzheimer’s, I thought it would be timely to review some natural and proven ways to keep our brains young, sharp and focused.

1. Reduce high blood pressure:  Good cognitive function is associated with systolic blood pressures (SBP) that range between 100-120 mmHg   In contrast, living with a high SBP (greater than 140 mmHg) raises the risk of developing age-deteriorating brain deposits (or amyloid plaques) that contribute to memory loss.  A study entitled “SPRINT-MIND” presented last week at the Alzheimer’s Association Annual meeting found that lowering systolic BP to less than 120 mmHg reduced memory loss by 15% compared to higher levels.  A word of caution: lowering blood pressure in older men and women should be done slowly and cautiously because an overly intensive regimen that lowers SBP too much (e.g., more than 20 mmHg) and too quickly (e.g., as measured in days rather than weeks) may result in dizziness, fatigue and possibly a stroke.  Therefore, a wise approach toward intensive blood pressure lowering should be aimed at gradual and sustained reductions that do not cause the symptoms outlined above.
2. Eat fish at least twice each week:  Fish consumption offers a wide range of benefits for both your heart and mind. Not only does brain function improve with fish consumption, but for every 2 portions (3.5 ounce or 100 grams) of fish consumed weekly,  the risk of Alzheimer’s is reduced by more than 20%.
3. Add turmeric to your meals: The rate of Alzheimer’s is lower in India and other countries where turmeric is a staple.  The principal ingredient of turmeric, curcumin is a powerful antioxidant and anti-inflammatory compound that also reduces amyloid deposits from forming. Unfortunately, turmeric at low doses is not well absorbed; to enhance absorption add 1/4 teaspoon of black pepper to 1 teaspoon (2000 mg) of turmeric to enhance these biologic effects.
4. Exercise: Physical activity not only boosts brainpower but may also reduce the probability of developing Alzheimer’s. The good news is that you do not need to run marathons to derive brain protection.  Simply add 30 minutes of moderate-exercise (walk at an average speed of 3 to 5 mph) at least 3 days weekly to reap the benefit.
5. Manage your Stress:  Everyone experiences stress but effective management on a day-to-day basis results in sharper focus and concentration.  On the other hand, chronic stress that is not managed effectively places you at increased risk of Alzheimer’s.  Check out “Heal Your Heart” to learn the most effective natural tools that I recommend to my patients for managing day-to-day stress and boost brain and heart health.                                                                                                                           Michael Miller, MD is Professor and cardiologist at the University of Maryland School of Medicine in Baltimore, Maryland USA.  His original research has been featured in numerous media outlets including The New York Times, Wall Street Journal, Toronto Globe & Mail and Times of India.

 

Unlocking 5 Keys to Happiness

When it comes to finding happiness, there are many simple things that raise your positive emotions quotient (PEQ).

Here are 5:

1. Own a pet:  Turns out that pet ownership not only raises your levels of happiness or PEQ but is also likely to reduce your risk of heart disease by lowering blood pressure, cholesterol levels and reducing obesity.
2. Have a mid-day snack:  Sometime between 1-3 PM is typically when the level of the brain neurotransmitter, serotonin falls and drive down mood so why not pick it up with a heart healthy snack.  My favorite recommendations that not only boost mood but also lower cholesterol and blood pressure include a medium sized apple, a handful of your favorite nuts or a serving of dark chocolate.
3.  Do small deeds for loved ones:  Doing small deeds for loved ones will not only raise endorphin levels but over time may reduce aging of your blood vessels.   Small deeds might include helping your spouse around the house, filling up her car with gas and bringing her a warm towel on a cold morning.
4. Enjoy laughter everyday:  Laughing is among the single best activities that promote happiness and good health and my friends who practice laughter yoga tell me that they rarely develop illness and have generally never felt better.
5. Appreciate yourself:  Enjoy your own downtime each day by taking at least 20 minutes to recharge.  That means no distractors, including cell phone, radio or TV. It might turn out to be the most restful and meaningful part of your day!
6. Dr Michael Miller is Professor of Cardiovascular Medicine at the University of Maryland School of Medicine in Baltimore.  You can read more about health, happiness and PEQ in his latest book: “Heal Your Heart: The Positive Emotions Prescription to Prevent & Reverse Heart Disease“.  All book proceeds are donated to the American Heart Association.