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 Does Vitamin D Reduce the Risk of Dementia?

There are several risk factors for the development of Alzheimer’s disease and vascular dementia. Based on an increasing number of studies linking these risk factors with Vitamin D deficiency, an article in the current issue of the Journal of Alzheimer’s Disease (May 2009) by William B. Grant, PhD of the Sunlight, Nutrition, and Health Research Center (SUNARC) suggests that further investigation of possible direct or indirect linkages between Vitamin D and these dementias is needed.

Low serum levels of 25-hydroxyvitamin D [25(OH)D] have been associated with increased risk for cardiovascular diseases, diabetes mellitus, depression, dental caries, osteoporosis, and periodontal disease, all of which are either considered risk factors for dementia or have preceded incidence of dementia. In 2008, a number of studies reported that those with higher serum 25(OH)D levels had greatly reduced risk of incidence or death from cardiovascular diseases.

Several studies have correlated tooth loss with development of cognitive impairment and Alzheimer’s disease or vascular dementia. There are two primary ways that people lose teeth: dental caries and periodontal disease. Both conditions are linked to low vitamin D levels, with induction of human cathelicidin by 1,25-dihydroxyvitamin D being the mechanism.

There is also laboratory evidence for the role of vitamin D in neuroprotection and reducing inflammation, and ample biological evidence to suggest an important role for vitamin D in brain development and function.

Given these supportive lines of evidence, Dr. Grant suggests that studies of incidence of dementia with respect to prediagnostic serum 25(OH)D or vitamin D supplementation are warranted. In addition, since the elderly are generally vitamin D deficient and since vitamin D has so many health benefits, those over the age of 60 years should consider having their serum 25(OH)D tested, looking for a level of at least 30 ng/mL but preferably over 40 ng/mL, and supplementing with 1000-2000 IU/day of vitamin D3 or increased time in the sun spring, summer, and fall if below those values.

Writing in the article, Dr. Grant states, “There are established criteria for causality in a biological system. The important criteria include strength of association, consistency of findings, determination of the dose-response relation, an understanding of the mechanisms, and experimental verification. To date, the evidence includes observational studies supporting a beneficial role of vitamin D in reducing the risk of diseases linked to dementia such as vascular and metabolic diseases, as well as an understanding of the role of vitamin D in reducing the risk of several mechanisms that lead to dementia.”

The article is “Does Vitamin D Reduce the Risk of Dementia?” by William B. Grant, Ph.D. It is published in the Journal of Alzheimer’s Disease 17:1 (May 2009).

Exercise, Vitamin D Seem to Cut Alzheimer’s Risk

Physical activity and adequate levels of vitamin D appear to reduce the risk of cognitive decline and dementia, according to two large, long-term studies scheduled to be presented Sunday at the International Conference on Alzheimer’s Disease in Hawaii.

In one study, researchers analyzed data from more than 1,200 people in their 70s enrolled in the Framingham Study. The study, which has followed people in the town of Framingham, Mass., since 1948, tracked the participants for cardiovascular health and is now also tracking their cognitive health.

The physical activity levels of the 1,200 participants were assessed in 1986-1987. Over two decades of follow-up, 242 of the participants developed dementia, including 193 cases of Alzheimer’s.

Those who did moderate to heavy amounts of exercise had about a 40 percent reduced risk of developing any type of dementia. People with the lowest levels of physical activity were 45 percent more likely to develop any type of dementia than those who did the most exercise. These trends were strongest in men.

“This is the first study to follow a large group of individuals for this long a period of time. It suggests that lowering the risk for dementia may be one additional benefit of maintaining at least moderate physical activity, even into the eighth decade of life,” study author Dr. Zaldy Tan, of Brigham and Women’s Hospital, VA Boston and Harvard Medical School, said in an Alzheimer’s Association news release.

The second study found a link between vitamin D deficiency and increased risk of cognitive impairment and dementia later in life.

Researchers in the United Kingdom analyzed data from 3,325 people aged 65 and older who took part in the third U.S. National Health and Nutrition Examination Survey. The participants’ vitamin D levels were measured from blood samples and compared with their performance on a measure of cognitive function that included tests of memory, orientation in time and space, and ability to maintain attention. Those who scored in the lowest 10 percent were classified as being cognitively impaired.

The study found that the risk of cognitive impairment was 42 percent higher in people who were deficient in vitamin D, and 394 percent higher in those with severe vitamin D deficiency.

“It appears that the odds of cognitive impairment increase as vitamin D levels go down, which is consistent with the findings of previous European studies. Given that both vitamin D deficiency and dementia are common throughout the world, this a major public health concern,” study author David Llewellyn, of the University of Exeter Peninsula Medical School, said in the news release.

Skin naturally produces vitamin D when exposed to sunlight. However, most older adults in the United States have insufficient vitamin D levels because skin becomes less efficient at producing vitamin D as people age and there’s limited sunlight for much of the year.

“Vitamin D supplements have proven to be a safe, inexpensive and effective way to treat deficiency,” Llewellyn said. “However, few foods contain vitamin D and levels of supplementation in the U.S. are currently inadequate. More research is urgently needed to establish whether vitamin D supplementation has therapeutic potential for dementia.”

Previous research has pointed to a number of factors that may be associated with cognitive decline and Alzheimer’s, especially cardiovascular risk factors, said William Thies, chief medical and scientific officer at the Alzheimer’s Association.

He added that “the Alzheimer’s Association and others have repeatedly called for longer-term, larger-scale research studies to clarify the roles that these factors play in the health of the aging brain.”

These new studies “are some of the first reports of this type in Alzheimer’s, and that is encouraging, but it is not yet definitive evidence,” Thies said in the news release.

— Robert Preidt

SOURCE: Alzheimer’s Association, news release, July 11, 2010


Open Your Eyes to the Importance of Sleep

Sleep is a very important part of your health, and as your private physician, I need to know about any irregularities you may be experiencing! Please do not suffer in silence. Trouble sleeping can indicate a larger health issue, and studies unequivocally show that good sleep is necessary for all kinds of bodily functions: physical, mental, and emotional. Below, you will find a list of common reasons for fatigue and steps to take toward fixing them. Please do not hesitate to contact me if any questions or concerns arise; my priority is always to help you feel your very best.

Fatigue Cause No. 1: Not Enough Sleep
It may seem obvious but you could be getting too little sleep. That can negatively affect your concentration and health. Adults should get seven to eight hours every night.
Fix: Make sleep a priority and keep a regular schedule. Ban laptops, cell phones, and PDAs from your bedroom. Still having trouble? Please talk to me! You may have a sleep disorder.

Fatigue Cause No. 2: Sleep Apnea
Some people think they’re sleeping enough, but sleep apnea gets in the way. It briefly stops your breathing throughout the night. Each interruption wakes you for a moment, but you may not be aware of it. The result: you’re sleep-deprived despite spending eight hours in bed.
Fix: Lose weight if you’re overweight, quit smoking, and sleep with a CPAP device to help keep airway passages open at night.

Fatigue Cause No. 3: Not Enough Fuel
Eating too little causes fatigue, but eating the wrong foods can also be a problem. Eating a balanced diet helps keep your blood sugar in a normal range and prevents that sluggish feeling when your blood sugar drops.
Fix: Always eat breakfast and try to include protein and low glycemic index carbohydrates, fruits and vegetables in every meal. For example, eat eggs with a side of plain Greek yogurt: add your favorite fresh fruit . Also eat meals and snacks throughout the day for sustained energy.

Fatigue Cause No. 4: Anemia
Anemia is a leading cause of fatigue in women. Menstrual blood loss can cause an iron deficiency, putting women at risk. Red blood cells are needed because they carry oxygen to your tissues and organs.
Fix: For anemia caused by an iron deficiency, taking iron supplements and eating iron-rich foods, such as lean meat, liver, shellfish, beans, and enriched cereal, can help.

Fatigue Cause No. 5: Depression
You may think of depression as an emotional disorder, but it contributes to many physical symptoms as well. Fatigue, headaches, and loss of appetite are among the most common symptoms. If you feel tired and “down” for more than a couple of weeks, please let me know!
Fix: Depression responds well to psychotherapy and/or medication.

Fatigue Cause No. 6: Hypothyroidism
The thyroid is a small gland at the base of your neck. It controls your metabolism, the speed at which your body converts fuel into energy. When the gland is under-active and the metabolism functions too slowly, you may feel sluggish and put on weight.
Fix: If a blood test confirms your thyroid hormones are low, synthetic hormones can bring you up to speed.

Fatigue Cause No. 7: Caffeine Overload
Caffeine can improve alertness and concentration in moderate doses. But too much can increase heart rate, blood pressure, and jitteriness. And research indicates too much actually causes fatigue in some people.
Fix: Gradually cut back on coffee, tea, chocolate, soft drinks, and any medications that contain caffeine. Stopping suddenly can cause caffeine withdrawal and more fatigue.

Fatigue Cause No. 8: Hidden UTI
If you’ve ever had a urinary tract infection (UTI), you’re probably familiar with the burning pain and sense of urgency. But the infection does not always announce itself with such obvious symptoms. In some cases, fatigue may be the only sign. A urine test can quickly confirm a UTI.
Fix: Antibiotics are the cure for UTIs, and the fatigue will usually vanish within a week.

Fatigue Cause No. 9: Diabetes
In people with diabetes, abnormally high levels of sugar remain in the bloodstream instead of entering the body’s cells, where it would be converted into energy. The result is a body that runs out of steam despite having enough to eat. If you have persistent, unexplained fatigue, ask me about being tested for diabetes.
Fix: Treatments for diabetes may include lifestyle changes such as diet and exercise, insulin therapy, and medications to help the body process sugar.

Fatigue Cause No. 10: Dehydration
Your fatigue can be a sign of dehydration. Whether you’re working out or working a desk job, your body needs water to work well and keep cool. If you’re thirsty, you’re already dehydrated.
Fix: Drink water throughout the day so your urine is light colored. Have at least two cups of water an hour or more before a planned physical activity. Then, sip throughout your workout and afterwards drink another two cups.

Fatigue Cause No. 11: Heart Disease
When fatigue strikes during everyday activities, such as cleaning the house or weeding the yard, it can be a sign that your heart is no longer up to the job. If you notice it’s becoming increasingly difficult to finish tasks that were once easy, please alert me!
Fix: Lifestyle changes, medication, and therapeutic procedures can get heart disease under control and restore your energy.

Fatigue Cause No. 12: Shift Work Sleep Disorder
Working nights or rotating shifts can disrupt your internal clock. You may feel tired when you need to be awake. And you may have trouble sleeping during the day.
Fix: Limit your exposure to daylight when you need to rest. Make your room dark, quiet, and cool. Many individuals benefit from using sound conditioners, also known as white noise machines. Still having sleep issues? Talk to us about supplements and medications that may help.

Fatigue Cause No. 13: Food Allergies
Some evidence suggests that hidden food allergies can make you sleepy. If your fatigue intensifies after meals, you could have a mild intolerance to something you’re eating — not enough to cause itching or hives, just enough to make you tired.
Fix: Try eliminating foods one at a time to see if your fatigue improves. You can also ask about a food allergy test.

Fatigue Cause No. 14: CFS and Fibromyalgia
If your fatigue lasts more than six months and is so severe that you can’t manage your daily activities, chronic fatigue syndrome or fibromyalgia are possible. Both can have various symptoms, but persistent, unexplained exhaustion is a main one.
Fix: While there’s no quick fix for CFS or fibromyalgia, patients often benefit from changing their daily schedule, learning better sleep habits, and starting a gentle exercise program.

Fast Fix for Mild Fatigue
If you have mild fatigue that isn’t linked to any medical condition, the solution may be exercise. Research suggests healthy but tired adults can get a significant energy boost from a modest workout program. In one study, participants rode a stationary bike for 20 minutes at a mild pace. Doing this just three times a week was enough to fight fatigue.



Sodium: A Good Thing…in Moderation

We may malign the salt shaker, but sodium plays an important role in the body. It’s essential for fluid balance, muscle strength, and nerve function. But most of us get too much. U.S. guidelines call for less than 2,300 milligrams of sodium per day — about 1 teaspoon of table salt. And half of Americans should drop to 1,500 milligrams a day.

Who Should Go Low-Sodium?
U.S. guidelines call for about half of Americans to limit sodium to 1,500 milligrams or less per day, including:
– People ages 51 and older
– African Americans
– People with high blood pressure, diabetes, or chronic kidney disease.
The American Heart Association recommends less than 1,500 milligrams per day. Eating less sodium can help lower blood pressure in some individuals. It can help reduce the risk of heart disease, stroke, and kidney damage in those with hypertension.

Track Your Sodium Intake
Unsure of how much sodium you’re getting every day? Keep a daily tally of the foods you eat and drink. Then calculate how much sodium is in each. Any surprises? The average American takes in 3,400 milligrams of sodium each day, well above the limits recommended for good health.

Surprisingly, most of our salt intake is hidden in the foods we buy at the grocery store. Here are a few common culprits:

Frozen Dinners
They’re quick. They’re easy. And they’re loaded with sodium. A 5-ounce frozen turkey and gravy dinner can pack 787 milligrams of sodium.
Tip: A “lighter” version may have less salt, but it’s no guarantee. Read the labels to be sure. It’s possible that “lighter” refers to fat only.

Ready-to-Eat Cereals
They seem safe enough, right? But take a closer look. Some brands of raisin bran have up to 360 milligrams of sodium per cup.
Tip: Mix half of your favorite cereal with half of a sodium-free choice. Or look for companies that make low-sodium cereals.

Vegetable Juices
Veggie drinks are a healthy way to get your 5-a-day, but they’re not always a smart choice if you’re watching your sodium. One cup of vegetable juice cocktail contains 653 milligrams of sodium.
Tip: Many brands make a low-sodium version of vegetable juice.

Canned Vegetables
While a handy substitute for fresh, canned veggies are typically laden with preservatives or sauces and seasonings that add extra sodium. A cup of canned cream-style corn may contain 720 milligrams of sodium.
Tip: Rinse vegetables thoroughly, or buy canned ones labeled “no salt added” or “low sodium.” Or check the freezer section, where you may have more luck finding an unsalted choice.

Packaged Deli Meats
One look at the sodium content in packaged meats should stop you in your tracks. Beef or pork dry salami (2 slices) can pack 362 milligrams of sodium.
Tip: Be a label reader. There’s no way around it — different brands and different meats have differing amounts of sodium. And beware: a “healthier” packaged meat may actually have more sodium than its higher-fat counterpart. Some brands have meats with 50% less sodium.

It’s a warm comfort food on a cold day, but look out — soups are typically loaded with sodium. For instance, a cup of chicken noodle soup (canned) contains as much as 866 milligrams of sodium.
Tip: Look for reduced-sodium versions of your favorites. And always check the label — you might find that one brand’s “Healthy” version actually has less sodium than the “25% Less Sodium” variety.

Marinades and Flavorings
Notoriously high-sodium offenders include Teriyaki sauce (1 tablespoon) which contains 690 milligrams of sodium, and soy sauce (1 tablespoon), which may contain up to 1,024 milligrams of sodium.
Tip: Even “lower-sodium” soy sauce packs a wallop, so use sparingly. Go for vinegar and lemon juice to enhance flavor — they naturally have less sodium. And try orange or pineapple juice as a base for meat marinades.

Spaghetti Sauce
Half a cup of spaghetti sauce may pack 525 milligrams of sodium — and that amount barely coats a helping of pasta.
Tip: Look for “no salt added” versions of your favorite pasta sauces.

Spicing It Up
Adding spices to an entrée can be an easy way to forgo the salt shaker. Just make sure there’s no hidden sodium in your selection. For example, canned jalapeno peppers (1/4 cup, solids and liquids) contain about 568 milligrams of sodium.
Tip: Go for the pepper in its natural form to ditch the sodium used in processing. Or use herbs and sodium-free spices instead.

Aw Nuts!
Rethink those salty peanuts. An ounce of dry-roasted, salted peanuts contains 230 milligrams of sodium. The same size serving of dry-roasted, salted mixed nuts has 190 milligrams.
Tip: For about the same amount of calories, an ounce of oil-roasted, salted peanuts rings in at only 123 milligrams of sodium. Or better yet, buy the unsalted variety, which are practically sodium-free.

The Obvious Offenders
These snack-time favorites are always a safe bet for high salt content. Here’s how a 1-ounce serving compares. Potato chips = 149 milligrams, Cheese puffs = 258 milligrams, Pretzels = 385 milligrams
Tip: Even “baked” or fat-free snacks can pack the same amount of sodium or more, so read the label.

Pre-Packaged Pitfalls
Foods such as rice, potatoes, and pasta in their natural forms are naturally low in sodium. But alas, once you grab the convenient “all-in-one” box and add the flavor packet, you may end up eating more than half of your daily allowance of sodium in just one serving.
Tip: Skip the packaged seasonings and choose wild rice cooked in sodium-free chicken stock.

Condiments Do Count
If you think those little extras you add to your food don’t count, think again. Here’s what 1 tablespoon contains.
Ketchup = 167 milligrams, Sweet relish = 122 milligrams, Capers = 255 milligrams (drained)
Tip: Go for low-sodium or sodium-free condiments. Or get creative with your substitutions: Try cranberry relish or apple butter for a naturally lower sodium choice.

Watch the Serving Size
Don’t fool yourself by thinking that the sodium content listed on a nutritional label is for the entire package. Before you blow your entire day’s worth of sodium, determine exactly what one serving equals.

Food Label Claims
Can’t keep up with the jargon? Here’s a cheat sheet:
• Sodium-free: Less than 5 milligrams of sodium per serving
• Very low-sodium: 35 milligrams or less per serving
• Low-sodium: Less than 140 milligrams per serving
• Reduced sodium: Sodium level reduced by 25%
• Unsalted, no salt added, or without added salt: Made without the salt that’s normally used, but still contains the sodium that’s a natural part of the food itself.

What’s in a Name?
When you’re scanning a food label, don’t just look for the word “salt.” Watch out for various forms of sodium or other names for the same thing:
• sodium alginate
• sodium ascorbate
• sodium bicarbonate (baking soda)
• sodium benzoate
• sodium caseinate
• sodium chloride
• sodium citrate
• sodium hydroxide
• sodium saccharin
• sodium stearoyl lactylate
• sodium sulfite
• disodium phosphate
• monosodium glutamate (MSG)
• trisodium phosphate
• Na

The first step in taking control of your sodium intake is education and awareness… so congratulations – you’re already on your way!