Sleep apnea and memory problems

You snooze, you lose. Neurons, that is, in charge of memory function, lost when you go apneic (quit breathing) while sleeping. Check out the details at Menopause moments.

Highways, blood vessels, and indoor air

A lot of research suggests that particles from outdoor air affect vascular function, especially at high doses. We wanted to see whether the concentration of airborne particles in a regular, normal home would be sufficient to cause similar effects, so we removed them, and indeed we found they had [adverse] effects.
---Dr. Steffen Loft, University of Aarhus, Denmark

The air here in central Denver hangs heavy in the winter and is downright visible in the summer. If ever I deluded myself in thinking that staying indoors protected me and mine from the crap in our air, Dr. Loft has proven otherwise.

Loft and company studied a delegation of Danes living near heavily trafficked roads(1). These old folks, ages 60 to 75, spent four consecutive days in their homes-- two breathing high-efficiency particle-air (HEPA) filtered air and two without. The filter removed 60% of the resident schmutz in their air and improved their flow-mediated dilation (FMD or FMV) by more than 8%. FMD is an indirect measure of the healthy function of blood vessels.

Is 8% a significant boost to vascular function? Again, per Dr. Loft: "...I believe people with overt, severe cardiovascular disease have a reduction in microvascular function in the region of 30% to 40%. I think this improvement is something like what you might expect from a well-working drug."
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(1)Brauner EV, et al. Indoor particles affect vascular function in the aged. An air filtration-based intervention study. Am J Respir Crit Care Med 2008. 177:419-425.

Yoga Toes vs. a Trip to the Orthopedist

They both cost me roughly the same--about $45. The former got me two clear plastic toe separators with a lifetime guarantee against breakage. The latter got me 5 minutes of his time, plus assurances that 1) my flatfeet were the source of my pain (I knew that) and 2) my posterior tendon was not hopelessly and permanently stretched (I didn't know that, but hoped it was true).

Here's my conclusion after one month of Yoga Toe workouts (stick your toes into the Yoga Toes, lie down, watch TV). Spend your money on them and skip the copay for the overpriced specialist. Compare and contrast:

December, 2007, I walk 5 blocks to an antique/thrift store on Colfax Avenue. My feet hurt so much that I wonder if I'll be able to make it home. No cell phone along on my retail adventure, so no choice but to hobble home.

May, 2008, I visit the Black Hills of South Dakota and scramble up a steep slope for 25 minutes to take in the breathtaking view (and try as I might, I can't make the guys there on Mt. Rushmore come through). I skid down (on feet not back end) and walk briskly back down the path to the car. No pain at all.

Lovaza

"And I'll need a script for Lovaza..."

Dang, one of those humbling moments. What on earth is Lovaza? Should I just ask or should I excuse myself for a moment on the pretext that I need a new prescription pad, then look it up quickly in the PDR? Well, by hook or by book, I found out what it was.

Lovaza is Omacor. Omacor, by any name, is a high potency omega-3 fatty acid supplement, but that particular name was entirely too similar to Amicar, a drug used to prevent or treat serious bleeding in hemophiliacs. Not that anyone would have trouble reading my writing, but if they should, that's a heckuva mistake to make.

I always ask my patients about the supplements they take during their annual exams. As a result, I know that most everyone is on to the fish oil fad instead of the previously top popular vites C & E. Research suggests that use of these oils can prevent sudden cardiac death(1), decrease risk of Alzheimer's disease(2), improve the mood(3), and lower triglycerides.

So why pay for fancy prescription strength Lovaza when you could do a 3 for 1 deal at Puritan.com(current sale price)? The two products have similar EPA and DHA content--one capsule of either the OTC or rx variety has roughly 1,000 mg of these worthy fatty acids which is the recommended dose for persons already diagnosed with coronary artery disease. Patients with elevated triglycerides (blood fats) should consider a daily dose of 4,000 mg.
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(1)Is it death or tuna casserole deficiency?
(2)Be the right sort of fat head
(3)Fishing for a good mood

Cough CPR

If you're like me, you've received multiple copies of the e-mail that sings the praises of coughing your way out of cardiac arrest. The method remains controversial and has earned itself a place on "urban legend" web-sites. A Polish cardiologist, however, continues to investigate the method and would like to pull it out of the mythic category into everyday practice.

Sudden cardiac death caused by rhythm abnormalities of the heart which cut off circulation to the heart and brain takes out 300,000 Americans each year. Dr. Tadeusz Petelenz notes that patients have a 20-30 second prodromal period prior to pitching marked by dizziness, shortness of breath, nausea, sweating, and weakness. If properly trained, a quick thinking cardiac patient can launch into cough CPR, maintaining consciousness long enough to call for help.

Animal studies support the physiology behind this maneuver. Forceful rhythmic coughing causes an upswing in pressure through the chest cavity. With each cough, blood is squeezed out of the lungs, back through the heart, and into blood vessels serving important organs such as the brain. With each deep inspiration between coughs, blood zips back through the right heart chamber and into the lungs and the coronary circulation.

Over 100 of Dr. Petelenz's at-risk patients were taught cough CPR and successfully hacked their way out of nearly 300 prodromal events. They required medical assistance through 73 events during which they were unable to cough up their blood pressure. Doubtful colleagues at the Annual Congress of the European Society of Cardiology objected that there was no coughless control group, but who would want to be assigned to that bunch of deadbeats now that Dr. P. has fair evidence that it works? If I were a patient at high risk for sudden cardiac death, I'd rather cough than wait to see if this prodrome was the big one.

Carotid bruits

We're always looking for an easy-to-use, 'crystal ball' of a test that will predict cardiovascular risk. Since we can't actually visualize the blood vessel walls, we use 'surrogate markers' that are more or less associated with unwanted future outcomes like stroke and heart attack.

The carotid arteries are well-placed for easy access as they head upwards through the neck on either side of trachea. Not only does atherosclerotic narrowing in these essential vessels increase risk for embolic stroke (where little bits of clot and cholesterol guck break off from the walls and block the blood supply to parts of the brain), the health of these vessels is a good predictor of overall vascular health.

Thickening of the carotid walls known as intimal-medial thickness or IMT is a known risk factor for heart attack and stroke. Although this can be measured without actually needling these big old arteries, and thank heavens for that, carotid ultrasound technology is not readily available in the average PCP's office. Advancing age, LDL-cholesterol levels, and diastolic blood pressure(1) are good current predictors of IMT thickening(2). These measurements can be used then as surrogate markers raising suspicion that a person rating high in all three areas might well have carotid artery disease.

The latest issue of The Lancet confirms that another test easily performed on aging persons during their annual physical provides additional cardiovascular risk assessment. Around the age of 50 or so, I begin to feel for normal pulsation in the carotid arteries (but not both at once as bilateral pressure on these vessels can induce fainting!) as well as listen with my stethoscope for the unwanted, rhythmic whish of a carotid bruit that occurs as the heart contracts and sends a surge of blood through narrowed old carotids.

Doctors from Walter Reed Medical Center analyzed data from thousands of carotid arteries and their attached humans with respect to risk of heart attack with or without death in follow-up. Those whose carotids hummed at outset were twice as likely to have a heart attack in the 2-7 years that followed, and had nearly thrice the risk of cardiovascular death.

So ask your doc to check up your neck at your next physical.
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(1)Diastolic pressure is the lower reading on blood pressure measurement which measures the amount of pressure in your blood vessels as your heart relaxes in preparation for the next beat. The upper or systolic number is the pressure generated as the heart contracts. Diastolic hypertension is also a known risk factor for abnormal thickening of the heart wall.
(2)Davis, PH, et al. Carotid Intimal-Medial Thickness Is Related to Cardiovascular Risk Factors Measured From Childhood Through Middle Age. Circulation. 2001;104:2815-2819.
(3)Pickett, CA, et al. Carotid bruits as a prognostic indicator of cardiovascular death and myocardial infarction: a meta-analysis. The Lancet. 2008; 371:1587-1594.

Methylfolate and depression

...or how to B undepressed.

Folate is a B vitamin that occurs naturally in green leafy vegetables. It plays a host of important roles in the human body, and is so essential to the proper construction of the nervous system of a developing human that the FDA mandated in 1996 that its synthetic form--folic acid--be added to breads, flours, and other grain foods.

The trouble with folic acid supplementation or even naturally occurring dihydrofolate from food sources is that the body must convert them into the active form which is L-methylfolate (known as MTHF--yes, I thought of that word too the first time I read it). Some people are better MTHF producers than others. For purposes of our discussion, we will focus on the effects of MTHF deficiency and the fully developed brain.

The brain is tightly guarded by the 'blood-brain barrier.' Certain molecules can't pass through the blood vessel walls into brain tissue, and folate is one of them. MTHF, on the other hand, slips right in, and a right good thing it does because it is an important co-factor in producing the three most important neurotransmitters involved in mood regulation. If you're low on MTHF, studies suggest that you may subsequently run low on dopamine, norepinephrine, and serotonin. We're talking transmitters with a capital T that rhymes with D that stands for depression.

A host of research shows that supplementing methylfolate--thus skipping the necessary internal steps to activate folic acid--improves depression under a host of circumstances. This being an older person's health blog, let me illustrate with one study which supplied sad, old people with MTHF.

Researchers coaxed 20 elderly people who were not only Italian but also depressed to take 50 mg daily of MTHF rather than antidepressants. Four said the Italian equivalent of 'what's the use' and quit. The remaining subjects showed significant improvement in their depressive symptoms.

But you don't have to be old to enjoy the potential mood elevation of MTHF. A product called Deplin is now available by prescription and specifically indicated for use in patients having a less than stellar response to antidepressants. Theoretically, it might also be useful for persons with mild mood disorders not on other medications.

The basic science literature supporting the theory that MTHF improves brain function is large, but clinical research, except for the random Italian or so, is sketchy. Thus Deplin has been designated a 'medical food' which apparently does not have the stringent proof requirements of prescription drugs. Nevertheless, no adverse effects of MTHF supplementation have occurred, and a downloadable coupon at deplin.com makes this an affordable gamble of a therapy.

Menopause moments

Milk in the cupboard, cornflakes in the 'frig. Women of 'a certain age' find these moments infinitely amusing...and definitely scary. Are we overwhelmed, inattentive, out of estrogen, or slipping down the road to dementia?

I invite you to check out my newish blog Menopause Moments. Share a momentary brain lapse that made you laugh, then read the latest research about what constitutes a menopause moment (aka senior moment), and what you can do to assure that yours will never become a permanent state of mind.

Unipedal standing

Less scholarly, perhaps, to just call it standing on one foot. Unipedal or onefooted, these Japanese orthopedists wondered if a daily balancing act might make old people less prone to pitch to earth and break their hips(1).

During their six month study, they divvied a pack of old folks at high risk of falling into two groups. The test subjects stood on one foot, then the other, one minute per side for three sessions each day. The other group just stood their ground in the usual manner.

Dr. Sakamoto previously calculated the load-bearing effects of stork-like posturing on the femoral head(2) or that part of the hip bone connected to the pelvic bone. This area is susceptible to loss of bone density and fracture when an old person goes to ground. He concluded that unipedal standing placed a load equivalent to 2.75 times the body weight on the involved femoral head, and one minute of time spent doing so was the equivalent of 53 minutes of walking with respect to benefits to bone density.

Let's see, one minute per side x 3 sessions per day equals six minutes of balancing acts vs. 318 minutes of walking. Well, how would you rather spend your discretionary time?

Alas, either six months is not long enough to determine the benefits of unipedal standing on old Japanese fogies, or you can't fool Mother Nature. At the end, there was a sort of significant decrease in falls in the test group compared to controls, and only one hip fracture in both groups.

I don't know whether I'm going to do this or not. Maybe if I could wear my Yoga Toes while balancing and thus do all my weird self-trials at once.
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(1)Sakamoto, K et al. Effects of unipedal standing balance exercise on the prevention of falls and hip fracture among clinically defined high-risk elderly individuals: a randomized controlled trial. J Orthop Sci. 2006 Oct;11(5):467-72.
(2)Sakamoto, K. Effects of unipedal standing balance exercise on the prevention of falls and hip fracture. Clin Calcium. 2006 Dec;16(12):2027-32.

Thanks to Jacob Schor, ND and his always excellent newsletter for calling my attention to these articles. You can subscribe at denvernaturopathic.com.

Stowed St. Francis in snow

Mom's St. Francis statue in his new home in Colorado Springs. Looks right at home, doesn't he? That snow is right here, right now, in not-so-sunny Colorado.

Photo courtesy of Tobi.