Vol. 159 December 1, 2016 Dementia Is Going Down, Weight Will Go Up

December 1, 2016

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The incidence (number of new cases per year) of dementia in the U.S. is apparently declining.

The Framingham Heart Study which has been monitoring 5,200 adults and 5,000 of their off spring since 1975 revealed in February 2016 that the decrease in the rate of new dementia cases was about 20% per decade. The FHS statistics are based on a variety of data sources including questionnaires, medical records, and some direct examinations.

A more recently published study using direct testing of a larger (21,000), more diverse, over 65 year old (average age: 75) U.S. population reveals that the incidence of dementia decreased from 11.6% in 2000 to 8.8% in 2012. In case you want to “study up” for your test, it included:
recalling 10 nouns immediately and then a little later
serially subtracting 7 from 100
counting backwards from 20

Those with more years of education had a lower risk of dementia. (better “test takers” obviously).
Diabetes increased the risk for developing dementia by 39%. Ominously the incidence of diabetes in this studied population increased greatly from 9% in 1990 to 21% in 2012. Despite that, the overall incidence of dementia did decrease. Nobody knows why.

The Framingham Heart Study findings showed that obesity increased the risk of dementia. In this study obese people had a 30% lower risk for dementia, and in fact, underweight people had a 2.5 fold increase in their risk!

As Dr. Denis Evans, one of the study’s authors, said, “Its very complex.”

dementia-cartoon

Speaking of obesity, the holiday eating season is upon us. Almost all of us expect to put on a little weight. Three scientists from three different countries (Finland, France, and U.S.) nicely graphed the average weight gains by month in three countries (Japan, Germany, and U.S.). No surprise. The Christmas season was the winner in all three countries, but Germany was the leader.

holiday-weight-gain

That Golden Week spike in Japan at the end of April and first week of May is when 5 of the 9 official Japanese holidays are clustered and most people take the whole week off.  (NEJM 375:12 Sept. 22, 2016, p. 1201)

Though the graph is impressive with its spikes and valleys the average weight gain in the U.S. measured in the 10 days after Christmas was only 0.7% or 1.33 pounds; much, much less than the 7-13 pound gains per week or two reported by some cruise ship travelers.

The bad news is that even though half of your holiday weight gain is lost shortly after the holidays, half of the weight gain remains until the summer … and beyond, which resets your baseline weight for the next year.
Oh, well. “Life is short. Have dessert first.”

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Vol. 137 December 1, 2015 Holiday Season Eating Advice

December 2, 2015

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“WHY LISTEN TO SO-CALLED HEALTH ‘EXPERTS’
WHEN THEY ARE ALWAYS CHANGING THEIR MINDS
ABOUT WHAT’S GOOD OR BAD TO EAT?”

With the passing of the Thanksgiving turkey we are officially in the “holiday season”. Weight gain during the 6 week holiday season represents 51% of our annual weight gain which is actually only about a pound or two on average. Much less than the average weight gain during a 7-day ship’s cruise of a pound a day. So, what foods should be avoided in the next 6 weeks?

JUNK FOOD?
Junk Food has been the traditional scapegoat for our increasing obesity. But, what is junk food? Decades ago I remember a very savvy pediatric endocrinologist, Dr. Gilbert Forbes, challenging a forum of physicians at a national pediatric meeting to define junk foods.
“Food high in sugar and carbohydrates”, was our immediate response.
“Like grandma’s apple pie?” was Dr. Forbes’ equally quick reply.
“Oh… high starch foods” was our second try.
“Like potatoes? How come all Germans aren’t fat?”
Our working definition after an hour or more of back and forth boiled down to “anything wrapped in cellophane or delivered by a vending machine.” Dr. Forbes’ point was that it is the total number of calories ingested and not any particular food that contributes to obesity.
Today that definition still holds true

In its inexorable march towards the truth medical science has just thrown a stone at the junk food glass house. A Cornell study (1) based on nearly 5,000 surveys done by the CDC in 2007-2008 surprisingly showed that for 95% of the people their BMI  (a measure of obesity) was NOT linked to soda, fast food, or even candy. The researchers expected to find that the more junk food people ate the more apt they were to be obese. Instead they found no correlation between eating junk food and a higher BMI; no link between junk food and obesity. The researchers concluded that it was our increased intake of grains and added fats that was driving up the number of calories consumed by the average American.  “Junk foods may not be the central difference between fat and thin. Limiting those foods is a part of a healthy diet, but it might not be the whole thing.” (2)

 SUGAR?
Sugar continues to get a bad rap, and we consume more and more sugar substitutes. But, as we say in medical science, “there ain’t no free lunch”. Studies showing that Canadian lab mice were more prone to develop bladder cancer if fed saccharine (Sweet and Low) certainly caused a bit of a flap until someone calculated the comparative human doses to be several shovelfuls a day. Sucralose (Splenda) is now under investigation because its effect on our gut bacteria may make us more prone to gain weight and develop diabetes. Like Fox radio news says, “We report, You decide.”

SALT?
Excess (added) salt does seem to correlate with higher blood pressure.  I don’t have the space here to summarize again the whiplash swings of research on salt and disease, but I can tell another story from the past that makes the point more succinctly.
A bunch of physicians (all male – I told you this was a story from the past) who were having lunch at the same table in a hospital cafeteria started remarking about the prodigious amount of salt a cardiologist was pouring on his food. As the discussion heated up, the cardiologist looked up from his plate and stopped it with a question, “How many of you have talked to your father in the past year.” Half of us raised our hands. “You guys can eat what you want. The others better watch their diets. You just have to pick your parents right.”

EGGS?
After decades of branding eggs as “bad” because of its cholesterol the federal government’s Dietary Guidelines Advisory Committee reported in 2015 that “eggs are OK.” A 1999 Harvard study showed that there was no correlation between an egg a day and the risk of heart disease in healthy people (3). 90% of our cholesterol is manufactured by our own liver as directed by our genes. Restricting our intake of certain fats can normally decrease our cholesterol level by about 10% at most.

WINE or BEER?
Previous studies have shown that wine drinkers seemed to experience less heart disease and certain cancers. Efforts to analyze why wine seemed so healthy resulted in tagging resveratrol, a chemical in grape skin, as the “active ingredient”. Dozens of nutritional supplements containing resveratrol ($12 – $25 for a month’s supply) immediately hit the market. Four Danish scientists thought that answer might be too simple and launched a study of what else those wine drinkers were buying at the food store. After examining 3.5 million store receipt transactions from 98 supermarkets they found that wine drinkers were more apt to buy olives, low-fat cheese, fruits and vegetables, low-fat meat, spices, and tea. Beer drinkers were more likely to buy chips, ketchup, margarine, sugar, ready-cooked meals, soft drinks, and, of course, beer. (4)

BOTTOM LINE for this holiday season?
“PICK YOUR PARENTS RIGHT, AND EAT AND DRINK IN MODERATION.”

References:
1. Boston Globe, B12, November 23, 2015, Megan Scudellari
2. David Just, Cornell University Professor of Applied Economics and Management
3. Boston Globe, March 15, 2015, Walter Willett, MD, Professor of Nutrition and Epidemiology, Harvard School of Public Health
4. The Dorito Effect: The Surprising New Truth About Food and Flavor, Mark Schatzker, May 2015 as reported in The Atlantic, June 2015


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