An Expert’s Advice on Symptoms of Alzheimer’s Disease

An Alzheimer’s Disease Doctor Answers Common Questions

By Colleen Davis Gardephe, Special to Lifescript

Published July 13, 2011

Reviewed by Edward C. Geehr, M.D.

“Plaques” and “tangles” are common terms doctors toss around when discussing symptoms of Alzheimer’s disease. But what are they, and when do they start to appear? A leading expert in Alzheimer’s diagnosis and treatment explains these key terms and talks about which genetic and lifestyle factors put you or your loved ones at risk…

Death rates from most major diseases have declined in the last 10 years, but not for Alzheimer’s disease. Mortality rates for the brain disorder jumped 66% from 2000-2008, according to the Alzheimer’s Association.

By 2030, 7.7 million people will have this degenerative, incurable form of dementia that destroys memory and eventually cognitive skills, the association predicts.

What triggers symptoms of Alzheimer’s? And if your mother had the disease, does it put you at higher risk?

Yes, according to Alan Jacobs, M.D., a leading specialist in Alzheimer’s treatment, memory disorders and neuroendocrinology who practices in New York.

“In general, if you have a first family member who had Alzheimer ’s disease, you’re 2-3 times more likely to get it yourself if you live to age 85,” he says.

In this exclusive Lifescript interview, Jacobs, a former Harvard and Cornell lecturer, discusses the causes and symptoms of Alzheimer’s and factors that can increase your risk.

What is Alzheimer’s disease?
Alzheimer’s disease causes problems with a person’s memory, thinking and behavior. Initially, a person may forget new information and, later, can become confused and irritable.

Eventually, the patient will have more serious memory loss and cognitive disability, and, at the end, experience physical changes, like difficulty swallowing, speaking and walking.

Alzheimer’s is thought to be the steady accumulation in the cerebral cortex of a protein called “beta-amyloid” – that [may] begin decades before clinical signs of overt memory loss appear, which is typically after age 65.

A person with Alzheimer’s has symptoms that develop slowly but become severe over time, so much so that they impede the person’s daily life.

What’s happening physiologically in an Alzheimer’s patient’s brain?
Dr. Aloysius “Alois” Alzheimer [who identified the symptoms of Alzheimer ’s disease in 1906] described abnormal clumps of a protein in the spaces between nerve cells. These are now called amyloid plaques.

He also described tangled fibers of another protein called tau (rhymes with wow) that build up inside cells. These are now called neurofibrillary tangles.

These plaques and tangles, along with the loss of nerve cell connections, are still the primary characteristics of the disease.

Which is a more important predictor of Alzheimer’s disease: plaques or tangles?
With modern imaging [techniques], it’s pretty safe to say that over a long presymptomatic stage occurring between the ages of 20 and 70, people accumulate amyloid first.

Eventually, tangles begin to form in a specific area of the brain called the entorhinal cortex, which is the gateway to the hippocampus, which controls memory. Once tangles appear, cells in this area start to die. That’s when a person becomes symptomatic with isolated insidious, progressive amnesia.

Tangles spread like wildfire through distinct pathways in the brain. That’s when the memory loss becomes accompanied with other clinical signs of the disease, like language and spatial/navigational troubles and then reasoning, and even behavioral/personality problems.

Can magnetic resonance imaging (MRI) or positron emission tomography (PET) scans detect plaques and tangles?
In the early stages of Alzheimer’s disease, an MRI won’t have a high enough resolution to see the development of plaques in the brain.

The Food and Drug Administration (FDA) recently approved use of a PET scan tracer that can image amyloid plaque in a living person. In the future, companies and doctors will use these scans to observe the development of amyloid because it’s a good biomarker for the presymptomatic phase of the disease, when treatment makes more sense.

Down the road, perhaps in a decade, people will probably be vaccinated against [the amyloid], or take a pill to prevent its accumulation of the amyloid.

Does family history increase the likelihood that you’ll develop Alzheimer’s?
Mutations in the genes for amyloid precursor protein (APP) presenilin-1 and presenilin-2 clearly lead to the familial early-onset form of Alzheimer’s disease, which can affect people in their 20s, 30s and 40s.

This group constitutes about 1 out of 10,000 people or families with the disease, so it is rare. Because it’s a simple model, this early onset version will probably be cured in the next 10 years.

But the general, sporadic form of the disease isn’t simple. [It’s] a massive web of complexity. They both take a person to Alzheimer’s.

The second group of genes involved in Alzheimer’s are disease-modifying or risk genes. We know of about five genes involved in the development of Alzheimer’s, with the APOE gene accounting for 30% or 40% of the genetic risk.

If a person has the APOE4 gene from one parent, their chance of getting Alzheimer’s increases 2-3 times. If they receive that gene from both parents, the risk climbs to 10 times normal.

What are some risk factors for developing symptoms of Alzheimer’s?
There’s a strong link between serious head injury and the development of Alzheimer’s.

If you have risk factors for heart disease, you may also [be at risk] for cerebral vascular disease, stroke, high blood pressure and high cholesterol, [which] are also risk factors for Alzheimer’s.

The connection between Alzheimer’s and diabetes is growing. If you have diabetes and high cholesterol in midlife, you are [also] more likely to get Alzheimer’s disease.

More and more research is linking insulin resistance in the brain to the further accumulation of amyloid.

The plaques and tangles in the brain are more likely to cause Alzheimer’s if there has been previous damage to the brain and its blood vessels from head trauma or a stroke.

Heavy drinking and a low education level are connected to increased risk for the disease as well.

Are some people less likely to develop symptoms of Alzheimer’s disease?
The more brain reserve you have, the more you can tolerate pathological signs of Alzheimer’s without showing the dementia.

People with high educational and occupational attainment who are physically fit have more brain connections, which seem to give them increased resilience.

Does that mean they don’t accumulate as much amyloid? Or are their brains better at dealing with it?
No one has really proven what is happening [in the brain]. But we know these people get the disease at a lower rate or push the onset of it later, all of which is good.

Can a healthy diet delay the onset of Alzheimer’s disease?
I don’t think it’s a matter of eating a particular food and protecting yourself from Alzheimer’s disease.

On the other hand, if you gain a lot of weight and develop diabetes in midlife, you’re stacking the deck against yourself and increasing the likelihood that you will get the disease sooner rather than later, say at 65 rather than 85.

To enhance your odds of not getting the disease, adopt a diet consisting of colorful fruits and vegetables and foods with plenty of antioxidants. It makes sense to consume less red meat and fewer processed foods, and reduce sugar consumption.

Eating three fish meals a week does seem to correlate with a lower risk of Alzheimer’s because the docosahexaenoic acid (DHA) in the omega-3 fish oils [protects] the brain.

Is depression a precursor to Alzheimer’s?
Many people who start transitioning from mild cognitive impairment to mild dementia get apathy – what we call abulia, the “bump-on-a-log” syndrome.

They no longer care about things that were previously important to them, like going to Florida for the winter or maintaining their garden.

Generalists not as familiar with Alzheimer’s say, “That seems like depression. I’m going to treat this person with Prozac.”

I usually see these people a year later, when the Prozac has done nothing to help them, and then treat them effectively with a cholinesterase inhibitor like donepezil [Aricept].

Which medications are currently prescribed for Alzheimer’s patients?
There isn’t a cure for the disease, but we have two classes of drugs to treat the symptoms of Alzheimer’s.

Cholinesterase inhibitors prevent the breakdown of acetylcholine, a chemical messenger that is key to learning and memory. Of this group, the most commonly prescribed medicines are Aricept, Exelon and Razadyne.

The other class of drug includes only memantine, branded as Namenda. It is also used to improve memory and cognition.

Potassium-Rich Foods May Offset Heart Risk of High Sodium, Researchers Say

By Ryan Flinn - Jul 12, 2011 4:00 AM GMT+0800

Foods rich in potassium such as blueberries and sweet potatoes may help offset heart risks associated with high-salt diets, a study suggests.

The research, which examined the diets of more than 12,000 people over an average of 15 years, found higher death rates from heart disease in those who had elevated sodium to potassium ratios. The report from the U.S. Centers for Disease Control and Prevention was published today in the Archives of Internal Medicine.

Public health authorities in most developed countries recommend reducing salt intake by roughly half. Still, studies that looked at sodium levels alone in relationship to heart disease have shown mixed results, with some finding no evidence that a low-salt diet reduces death rate or cuts cardiovascular complications. Today’s study found a higher correlation between the ratio of sodium to potassium and heart disease and death than just looking at salt or potassium alone.

“The association between sodium and cardiovascular disease is not straight forward and remains an area of controversy today,” said Elena Kuklina, one of the study’s authors and an epidemiologist at the Atlanta-based CDC, in an interview.

The results may be due to the nutrients offsetting each other, Kuklina said.

High levels of sodium can stiffen endothelial cells, thicken and narrow resistance arteries and block nitric oxide synthesis, while high potassium levels can spur nitric oxide release, counteracting the effects of sodium.

“Reduced sodium intake accompanied by increased potassium intake could achieve greater health benefits than restricting sodium alone,” the study said.

Processed Food Ratios

Processed foods, such as cheese, cooked meats and fast food tend to have a higher sodium-to-potassium ratio, whereas fruits, dairy products and vegetables tend to have a lower ratio, according to the study.

“If you just try to stick to unprocessed food, you would have low sodium and high potassium intake,” Kuklina said.

The findings are from the CDC’s National Health and Nutrition Examination Survey, a program that uses surveys and physical examinations to assess the health and nutrition status of Americans.

Coffee Protects Against Drug-Resistant Germs in Latest Baffling Benefit

By Elizabeth Lopatto - Jul 12, 2011 5:00 AM GMT+0800

Drinking tea and coffee may be linked to reducing antibiotic resistant bacteria carried by healthy people in their noses, a potential benefit of the beverages that baffled researchers.

People who consumed tea and coffee carried methicillin- resistant Staphylococcus aureus, or MRSA, in their noses half as often as those who didn’t, according to a study released today in the Annals of Family Medicine.

MRSA can live in people’s noses without infecting them. It grows and multiplies there, in a process called colonization. Colonized people can spread MRSA to others or become infected through a break of the skin. It is considered a risk for contracting the infection, said Eric Matheson, the study author and a doctor in the department of family medicine at the Medical University of South Carolina in Charleston.

“Oral consumption, which is the way most of us drink our tea and coffee, does seem to help, but no one is sure why,” said Matheson in a telephone interview.

Coffee and tea may activate the immune system, or directly damage cells of the bacteria, Matheson said. Both also decrease iron absorption, and MRSA needs iron to grow.

Coffee has been linked in studies to a lower risk of prostate cancer, Parkinson’s disease, Type 2 diabetes, liver cancer, cirrhosis and gallstone disease, Harvard University researchers said in a May 17 analysis in the Journal of the National Cancer Institute. It also contains compounds that can reduce inflammation and regulate insulin.

Researchers in the study, of 5,000 people, swabbed bacteria from people’s noses to see if they carried MRSA and asked them to answer questions about their beverage consumption. Iced tea and soda had no effect on MRSA, the study found. That may be because the antimicrobial parts of coffee and tea are carried to the nose through steam, the authors wrote.

If the findings hold true in further studies, coffee and tea may prove inexpensive ways to keep MRSA to a minimum in the population, the authors wrote.

MRSA is the most common drug-resistant strain of bacteria, often acquired in hospitals, according to the U.S. Centers for Disease Control and Prevention. The hospital-acquired strain sickens about 90,000 people a year in the U.S. and kills about 15,000, according to the Atlanta-based CDC.

10 Ways to Lower Your Cholesterol Naturally

10 Ways to Lower Your Cholesterol Naturally

By Carly Young, Special to Lifescript

Published November 13, 2009

What’s the nation’s No. 1 killer of women? Heart disease. It causes one death every 35 seconds. Janet Bond Brill, a registered dietitian and author of Cholesterol Down (Three Rivers Press), shares 10 tips to reduce the bad stuff. Plus, test your heart-health IQ with our quiz...

Cholesterol and Heart Disease

In the annual physical, your doctor checks your cholesterol levels. But what is it? And what do the numbers say about your health?

Cholesterol is a type of lipid or fat. In our bodies, it travels through our blood stream in particles called lipoproteins. Low-density lipoproteins (LDL) are bad because they can lead to a buildup of plaque in arteries.

A mass of plaque can narrow your arteries and restrict blood flow – much like trying to sip juice through a clogged straw. Eventually, the plaque ruptures and a blood clot forms, cutting off the flow of blood, oxygen and nutrients to the brain. Hello, heart attack and stroke!

High-density lipoproteins (HDL), on the other hand, are good because they pick up the LDL clogging your arteries and take it to the liver, where it’s processed and eventually excreted.

A total blood cholesterol level of 200 and above is cause for concern, according to the American Heart Association.

Chow Down

“Lowering your cholesterol reduces your risk of contracting heart disease and dying from a heart attack,” Brill says.

What you eat can affect the amounts of HDL and LDL flowing through your bloodstream, and Brill has a cholesterol-lowering eating plan that’s tasty and effective. “My diet is about what you can eat – not what you can’t,” she says.

What’s on her list? Try these 8 super-foods. Aim to eat all eight daily and heed the two bonus tips as well:

1. Oatmeal

Oats are rich in beta-glucan, a soluble fiber that acts like a sponge to soak up cholesterol.

How to sneak it in: Add cinnamon or dried cranberries to your morning oatmeal for a flavor boost. Oat-bran is a highly concentrated source of beta-glucan and it’s easy to mix into homemade bread, muffin and pancake batter.

Check out these Oatmeal Chocolate Chip Cookies.

Brill’s daily Rx: 3 grams of beta-glucan, found in a half cup of dry oatmeal or oat bran.

2. Almonds

Almonds contain two powerful antioxidants – vitamin E and flavonoids – which prevent the oxidation of LDL, a precursor to plaque buildup.

How to sneak it in: Eat almonds with their skins, which pack a hefty dose of flavonoids. Stir a handful into yogurt or spread two tablespoons of almond butter on whole-wheat bread.

Make these Spiced Spanish Almonds for a snack.

Brill’s daily Rx: One ounce of dry-roasted, unsalted almonds.

3. Flaxseeds

Flaxseeds contain lignan and soluble fiber, which block the production of LDL and increase your body’s ability to get rid of cholesterol.

How to sneak it in: Eat ground flaxseeds rather than whole ones, because your body can better absorb its nutrients. Brill likes to sprinkle them into her morning oatmeal. New studies also show that whole flaxseeds are better than flaxseed oil for lowering cholesterol.

Use whole flaxseed in these Blueberry-Maple Muffins.

Brill’s daily Rx: 2 tablespoons of ground flaxseeds.

4. Garlic

Garlic impedes the liver’s ability to make cholesterol.

How to sneak it in: Chop garlic into small pieces to release its flavor. Sauté it with steamed spinach, add it to sauces and soups or purée roasted garlic with cooked potatoes and olive oil for a heart-healthy version of everybody’s favorite: mashed potatoes.

Or try this Creamy Cauliflower Puree.

Brill’s daily Rx: One clove and one Kyolic One Per Day Cardiovascular aged garlic extract supplement.

5. Phytosterol-Containing Foods

Phytosterols are a fat found in plant foods such as fruits, nuts, seeds and vegetable oils. They interfere with cholesterol absorption by blocking it from your intestinal cells.

How to sneak it in: Even a vegetarian diet provides no more than 300-400 mg of plant sterols a day, well below Brill’s recommendation.

So supplement this with foods containing added phytosterols – chocolate bars, margarine, cheese, granola bars and cookies, to name a few – but keep an eye on saturated fat and trans-fat content.

Check out this Cranberry-Almond Granola.

Brill’s daily Rx: 2-3 grams of phytosterols a day spread over two meals.

6. Apples

Apples, particularly the skin and outer flesh, are rich in polyphenols, powerful antioxidants that help prevent plaque buildup.

How to sneak it in: Chop, slice or dice ’em, but leave the peel on for maximum health benefits.

Try this Jicama-Apple Slaw recipe.

Brill’s daily Rx: One apple – to keep the doctor away, of course.

7. Beans

Beans contain a special soluble fiber that’s fermented in the colon. Healthy bacteria eat the fiber and bean sugars to form short-chain fatty acids, which travel to the liver and inhibit LDL cholesterol production.

How to sneak it in: Brill loves Adzuki beans, which are used in Japan to make sweet red bean paste.

She also recommends cannelloni beans (try them in Tuscan soups, an Italian bean-based soup) and kidney beans, perfect in Southwestern chili.

Make this Pasta Bean Soup.

Brill’s daily Rx: 1/2 cup of legumes (beans, peas or lentils).

8. Soy Protein

Soy protein contains phytoestrogens – compounds that increase the number and effectiveness of LDL cholesterol receptors, improving the liver’s ability to get rid of cholesterol in your bloodstream.

How to sneak it in: Order a soy latte at your favorite coffeehouse, throw tofu into a fruit smoothie, use soy flour when baking, or mix a handful of roasted soy nuts with dried fruit for an energy-boosting trail mix.

Try this TLT (Tofu, Lettuce & Tomato Sandwich) for lunch.

Brill’s daily Rx: 20–25 grams.

Two More Tips

A healthy diet isn’t your only defense against cholesterol.

“Every step works to lower cholesterol in a specific way,” Brill says. “By combining them all, you get an extremely powerful LDL-lowering approach.”

Here are two of her favorite non-food-related tips:

9. Take Metamucil (Psyllium Husk)

Metamucil contains psyllium husk, a fiber that prevents cholesterol from entering intestinal cells. This fiber soaks up cholesterol so you excrete it rather than absorb it into your body.

It’s “the most powerful LDL-lowering viscous soluble fiber in existence,” Brill says.

How to sneak it in: Adults should consume 10-25 grams of soluble fiber a day, advises the National Cholesterol Education Program, but most get only 3-4 grams.

Brill says you should get half your fiber from a supplement and the rest from food.

Take half your daily dose of Metamucil before breakfast and half after dinner to avoid overloading your body on fiber, which can cause gas, constipation or diarrhea.

Brill’s daily Rx: Work up to 12 capsules a day, for a total of 6 grams of psyllium husk.

Or use the powdered version, which you can mix into water. It varies by product, but most Metamucil powders contain 3.4 grams of psyllium husk per serving.

10. Work Up a Sweat

Brisk exercise speeds blood flow in your arteries, reducing your chances of inflammation and clogging (two precursors to hardening of your arteries).

How to sneak it in: You don’t have to hit the gym to get some exercise. Clip on a pedometer while you run errands and aim for 10,000 steps a day.

Brill’s daily Rx: 30 minutes of exercise.

Start incorporating these foods and tips into your lifestyle today.

Lactose-Free Ways to Bone Up on Calcium

Lactose-Free Ways to Bone Up on Calcium

By Carole Jacobs, Special to Lifescript

Published July 02, 2011

Does a glass of milk bring on cramps, diarrhea and gas? If so, how do you build strong bones to avoid osteoporosis? From tofu, almonds, leafy greens, canned salmon and more, here are 9 foods that will help you get your daily calcium when you're lactose intolerant. Plus, how much do you know about food? Take our quiz to find out…

Dairy products are a woman’s best friend for calcium. But if you’re lactose intolerant and can’t drink milk or eat ice cream and cheese, you’re at risk for osteoporosis.

When your body doesn’t get enough of this essential mineral, it pulls it from your bones, making them progressively weaker, says Michael F. Holick, Ph.D., M.D., professor of medicine at Boston University Medical Center and editor of The Vitamin D Solution (Penguin).

Women 50 and younger need at least 1,000 milligrams (mg) of calcium a day for strong bones and teeth as well as other body processes, including blood clotting, muscle contraction, digestion, nerve function and getting nutrients into cells.

Those 51 or older require a minimum of 1,200 mg daily, according to new guidelines from the Institute of Medicine, an arm of the National Academy of Science.

So if you avoid dairy products, you have to work hard to get enough calcium through other foods and supplements, says registered dietitian Susan Kasik-Miller, M.S., clinical dietitian at Sacred Heart Hospital in Eau Claire, Wis.

What can dairy-dodging women do to bone up? Read on to find out other top calcium sources.

1. Tofu

A typical serving size – a quarter block of tofu – has 163 mg, or a tenth of the recommended dietary amount (RDA) of calcium, according to the USDA Nutrient Database for Standard Reference.

Dish it up: Tofu is delicious in stir-fries, salads and soups. Or use it to make lactose-free meat casseroles and desserts.

Don’t know how to cook with tofu? Eat this: Asian Tofu Salad.

2. Calcium-fortified orange juice

One cup contains 300 mg of calcium.

Dish it up: Drink a glass with meals, or use it instead of milk or water to make cakes, muffins, cookies and smoothies.

Try this: Wake-Up Smoothie.

3. Almonds

Two handful of almonds (about 24) produce 75 mg of calcium and lots of fiber, so munch away.

Dish it up: Enjoy as a snack or add to stews, casseroles and desserts. Substitute almond flour for bleached wheat flour in desserts.

Here’s a healthy snack: Almond-Honey Power Bar.

4. Beans

Pinto, chickpea, kidney and baked beans are loaded with fiber and protein and provide about 80 mg of calcium per cup.

Dish it up: Cook beans as a side dish; toss into salads, soups and stews; or mash chickpeas with garlic for homemade hummus.

Whip up this winter dish: Acorn Squash Stuffed with Chard & White Beans.

5. Leafy greens

A cup of collard greens has 288 mg of calcium, turnip greens provide 167 mg, and bok choy contains 158 mg.

Other good calcium sources include broccoli, Chinese cabbage and kale. But avoid spinach, which is loaded with oxalates, a type of salt that blocks calcium absorption, says registered dietitian Joy Blakeslee, culinary and nutrition center director at Publicis Culinary and Nutrition Center in Seattle.

Dish it up: “Steam or stir-fry veggies to preserve nutrients,” Blakeslee says.

Ladle over brown rice or pasta; add to casseroles; stews or soups, toss into salads; or use as sandwich stuffers.

If cleaning or preparing fresh greens sounds like too much trouble, buy flash- frozen vegetables. The rapid-freezing technique retains all nutrients, Blakeslee says.

Try this warming soup: Collard Green & Black-Eyed Pea Soup.

6. Soy nuts

These are soybeans that have been soaked in water and baked until crisp and brown. They come in oodles of flavors – from paprika to chocolate- and yogurt-covered – are high in protein and have 261 mg of calcium per cup.

How to eat them: Take a baggie along for energy on the go.

Satisfy your sweet tooth with this snack: Mix 4 cups of soy nuts with 1/2 cup maple syrup. Spread on a cookie sheet and bake them again for 10-12 minutes at 350 degrees.

7. Canned salmon

Three ounces of canned salmon contains 181 mg of calcium. Canned has more calcium than fresh because it contains small bones you can eat. Plus, it’s rich in protein and heart-healthy omega-3 fatty acids.

Dish it up: Enjoy salmon plain on crackers, or in salads, fish soups, stews and casseroles.

Try this recipe for Easy Salmon Cakes.

8. Canned sardines

These tiny critters are loaded with 325 mg of calcium per 3-ounce serving.

Dish it up: Nibble alone or with toast for a quick lunch.

9. Yogurt

Just because you’re lactose-intolerant doesn’t mean all dairy products aren’t off limits. Your body still may produce small amounts of lactase, the enzyme required to digest lactose, a milk sugar, says Barbara DeMarco, M.D., author of The Bone Building Solution (John Wiley & Sons).

“Some women discover they can gradually reintroduce dairy products by eating small amounts at a time; others find they can’t tolerate any,” she says.

For example, you may be able to eat yogurt, which contains as much calcium and protein as a glass of milk – 415 mg per cup – but less lactose.

That’s because the live bacteria (lactococcus and lactobacillus) that ferment milk reduces the milk sugar, says registered dietitian Dee Sandquist, M.S., spokeswoman for the American Dietetic Association.

Also, try lactose-free dairy products, which have as much calcium and protein as regular cow’s milk and may be fortified with vitamin D, advises Blakeslee. The vitamin is needed to help your body use calcium effectively.

Dish it up: Enjoy yogurt by the cup or glass, substitute it for regular milk in cooking and baking, and use it to make smoothies.

Jumpstart your day with this nourishing parfait: Pina Colada Yogurt Parfait.

Supplement Your Non-Dairy Diet

Anyone who avoids dairy should take a calcium supplement, says registered dietitian Kasik-Miller.

“Fruits and vegetables only have a fourth or sixth as much calcium as dairy products,” she says. “You need to eat a lot of them to meet your calcium needs.”

But the shelves are packed with calcium supplements. How do you know which to choose?

The most common supplements are calcium carbonate and calcium citrate, says Kasik-Miller.

Calcium carbonate has the highest amount of elemental calcium – 40%. It’s not expensive – $8 online for 100 capsules – and best absorbed when taken with food.

Calcium citrate, with 21% elemental calcium, costs more, $11 online for 100 capsules. But for postmenopausal women, calcium citrate is better at preventing bone loss, produces higher serum calcium levels and is better absorbed than calcium carbonate, according to a comparison of calcium supplements published by the American Academy of Family Physicians. It’s best to take all calcium supplements with meals to further boost absorption. Many calcium supplements also contain vitamin D and magnesium, which improve absorption.

Holick advises taking a calcium supplement with vitamin D because food and exposure to sunlight don’t necessarily provide the minimum 600 IU (international units) now recommended by the IOM for women under 71. The Office of Dietary Supplements at the National Institutes of Health says healthy adults can safely take up to 4,000 IU.

“If you live in a rainy climate, are vegetarian or vegan, wear sunscreen or have dark skin, you may not be getting enough vitamin D, since only a few foods have it, including egg yolks, salmon, some mushrooms and vitamin D-fortified foods,” Holick says.

To get the most from a supplement, follow these tips:

Look for supplements labeled lead-free (or the United States Pharmacopeia (USP), symbol, which means the product meets official standards for purity, quality, strength and consistency), according to the Linus Pauling Institute at Oregon State University. Besides the danger of lead poisoning, which causes problems with the central nervous system, digestion and kidney, the heavy metal blocks absorption of calcium.

If you’re on iron supplements, take them two hours before or after you take calcium supplements to get the maximum benefit from both minerals. Calcium can interfere with iron absorption.

If you’re taking acid blockers for indigestion, reflux or other gastrointestinal conditions, take calcium citrate (which does not require an acidic environment to be absorbed) instead of calcium carbonate, according to the Osteoporosis Prevention and Treatment Clinic (OPTC) at the University of Alabama at Birmingham.

Take supplements 2-3 times daily. Your body can absorb only 500-600 mg of calcium at a time, according to the OPTC.

If your calcium tablets cause bloating, flatulence or constipation, take them with meals or try a different form, such as a gel capsule. Tablets could contain binders such as corn starch or microcrystalline cellulose.

Couch Potatoes May Head to Early Death: Report

Couch Potatoes May Head to Early Death: Report
By Nicole Ostrow - Jun 15, 2011 4:00 AM GMT+0800

They found that among a group of 100,000 people, each two-hour increase in television watching per day was associated with 176 new cases of type 2 diabetes, 38 new cases of fatal heart disease and 104 deaths a year. Photographer: Floresco Productions/Getty Images
Watching television, America’s most- popular daily activity after sleeping and working, can raise the risk of diabetes, heart disease and premature death when people do it for too long, according to an analysis of eight studies.
For every two hours of TV viewing, the risk of type 2 diabetes increased 20 percent, the risk of cardiovascular disease rose 15 percent and the risk of early death rose 13 percent, according to the research published today in the Journal of the American Medical Association.
In the U.S., people watch an average of five hours of television a day, the report found. The findings suggest people reduce their TV viewing in exchange for activities that require more physical exertion to help combat an unhealthy, sedentary lifestyle, researchers said.
“Spending too much time watching TV is bad for health,” said Frank Hu, an author of the report and professor of nutrition and epidemiology at Harvard School of Public Health in Boston, in a June 12 e-mail. “Couch potatoes should be aware of the health hazards of prolonged TV watching habits. Perhaps TV programs or manufacturers should carry a warning label about the health hazards.”
Hu, along with co-author Andres Grontved, a visiting researcher in the Harvard School of Public Health’s Department of Nutrition, analyzed studies from the U.S., Europe and Australia that linked television viewing with an increased risk of type 2 diabetes, cardiovascular disease and premature death.
104 Deaths
They found that among a group of 100,000 people, each two- hour increase in television watching per day was associated with 176 new cases of type 2 diabetes, 38 new cases of fatal heart disease and 104 deaths a year. Europeans and Australians spent an average three to four hours watching TV each day, less than Americans.
Lack of exercise, an unhealthy diet and obesity can explain the higher risk of diabetes, cardiovascular disease and death in those who watch television, Hu said.
“Sedentary lifestyle, especially prolonged TV watching, is clearly an important and modifiable risk factor for type 2 diabetes and cardiovascular disease,” Grontved said in a statement. “Future research should also look into the effects of extensive use of new media devices on energy balance and chronic disease risk.”
More than 220 million people worldwide have diabetes and about 90 percent of them have type 2, where the body doesn’t use insulin effectively, according to the World Health Organization. Cardiovascular disease is the No. 1 cause of death worldwide, killing more than 17 million people each year, according to WHO. By 2030, more than 23 million people will die from cardiovascular diseases, mainly from heart disease and stroke, according to the organization.
Life Balance
Jen Brennan, clinical nutrition manager at Lenox Hill Hospital in New York, said in a June 10 telephone interview that people need to balance their TV viewing with good diet and exercise.
“I do believe it comes down to choices people are making in their lives,” said Brennan, who wasn’t an author of today’s report. “People need to learn to make healthy lifestyle choices. If they’re choosing to incorporate television into their life, they need to be mindful of the way they’re eating and their other activity throughout the day so they maintain balance in their lives.”

7 Ways to Prepare for Alzheimer's Disease

Learn the Facts and Risks of the Progressive Brain Disorder

Alzheimer’s disease is the most common brain disorder among those 85 and older. It affects all types of memory function – from recognizing loved ones to tying your shoes. We asked doctors, attorneys and elder-care specialists for advice on spotting telltale signs of dementia and how to put financial and medical stopgaps in place for you and your family…

It starts with simple loss of memory – forgotten words and names, lost objects. Over time, people with Alzheimer’s disease forget the past, their loved ones and how to do simple activities.

Not only does Alzheimer’s disease cause a person to decline slowly, it also requires care for as many as 10-15 years – draining loved ones of energy and often depleting life’s savings.

“Anyone who’s watched a loved one go through Alzheimer’s disease feels traumatized,” says Richard Caselli, M.D., professor of neurology at the Mayo Clinic Arizona and clinical core director for the Arizona Alzheimer’s Disease Center. “It’s frightening to see a capable person brought to total dependency.”

Alzheimer’s disease is the second-most feared illness among Americans, trailing only cancer, according to a February 2011 telephone survey of 1,007 Americans conducted by Harris Interactive for the MetLife Foundation.

Of those surveyed, few had done any planning for long-term illness. Only 41% had talked to their families about the possibility of suffering a brain disorder. Just 21% had made financial arrangements, and only 33% had considered care options.

But, experts agree, it’s best to plan for Alzheimer’s before signs of dementia hit. In fact, you should consider these issues as you plan for retirement, says Rajiv Nagaich, an elder law attorney in the Seattle area and a board member of the National Association of Elder Law Attorneys.

Use your fear to take action, advises Lauren Kessler, author of Dancing with Rose: Finding Life in the Land of Alzheimer’s (Viking Adult). After her mother died from the disease, she worked in an Alzheimer’s care facility.

First, learn about the brain disorder, Kessler advises. Then follow these 7 expert-recommended tips.

1. Understand the risks.
Statistics tell only part of the story. As many as 5.4 million Americans currently have Alzheimer’s disease, and deaths from the illness rose by 66% between 2000 and 2008, according to the Alzheimer’s Association (AA).

If your parent has or had Alzheimer’s disease, you’re at a greater risk for signs of dementia.

Alzheimer’s research has identified a gene called APOE-e4 which may be responsible for as many as 25% of Alzheimer’s cases, according to the AA.

But most doctors don’t recommend genetic testing – even if your relatives had Alzheimer's.

That’s because APOE-e4 is “not a perfect predictor,” Caselli says. “It doesn’t tell us when, or if, somebody will develop Alzheimer’s disease.”

The greatest risk factor is something you can’t prevent: old age.

According to the AA, most people with the disease are age 65 or older, and the risk of developing it doubles every five years after that. Of Americans aged 65 and over, 1 in 8 has Alzheimer’s, and nearly half of people aged 85 and older have signs of dementia.

Early-onset Alzheimer’s – which strikes before age 65 – has a stronger genetic link. But it's also relatively rare, accounting for fewer than 5% of all cases.

2. Keep your heart healthy.
Protecting your heart can reduce risk slightly, says Deborah Blacker, ScD, M.D., director of the Gerontology Research Unit at Massachusetts General Hospital in Boston.

“Anything you can do to reduce your risk of cardiovascular disease,” such as eating well and exercising, reduces your risk of dementia, she says.

Observational studies – based on autopsies of Alzheimer’s patients – indicate this may be because vascular damage to the brain (such as that caused by small strokes) can add to signs of dementia.


A 2004 study of 153 deceased members of the Catholic clergy – known as the Religious Orders Study –found the presence of one or more infarctions (death of tissue due to obstructed blood supply) increased risk of dementia by 2.8-fold.

Each heartbeat pumps 20%-25% of your body’s blood to your head. Your brain cells rely on this blood as a source of food and oxygen, making the health of your heart vital to mental acuity.

3. Watch for confusion or personality changes.
Don’t worry about occasional memory lapses, says Caselli.

“We all lose our keys or forget an appointment from time to time.”

Signs of dementia go beyond simple loss of memory.

“If you – or those around you – see a change in use of language, movement or judgment, it’s time to get things checked out,” he says. The exact changes will be different for everyone, he adds. But the time to become concerned is when they’re noticeable and affect daily life.

Here are some visible red flags of Alzheimer’s disease:
• Loss of memory that disrupts daily life
• Difficulty planning or solving problems
• Difficulty completing familiar tasks
• Confusion with time and place
• Trouble understanding visual images and spatial relationships
• New problems remembering words
• Misplacing things and losing the ability to retrace steps
• Decreased or poor judgment
• Withdrawal from work or social activities
• Changes in mood or personality
4. Talk to your family.
“You need to have a discussion with your children about illness in general, before the disease strikes,” Kessler says.

Tell your family your wishes, and speak with them openly about how you want your care to be handled if you get a brain disorder and your judgment is impaired.

“Alzheimer’s is a family affair,” Caselli says. “The patient doesn’t make decisions or manage his own care. It’s the caretaker who drives him, looks after his finances and supervises him round the clock.”

5. Make legal and financial decisions early.
“Whether or not you’re at risk for a brain disorder, it’s wise to prepare for long-term disability,” Caselli says. “There are other conditions (such as stroke, cancer and heart disease) that can disable you, and it can happen to any of us.”

It’s best to consult a financial planner or lawyer with a specialty in elder law, says Nagaich.

“The most critical thing is to set up your estate so you don’t become a burden on children and loved ones,” he says.

Ask your lawyer or financial planner to investigate whether you qualify for Medicaid or veteran’s benefits. (Medicare will not cover long-term care, he says.) Look into setting up a trust or purchasing long-term care insurance for your family to draw from if they need to pay for your care.

Also consider setting up a power of attorney so your family can step in and manage your affairs. Consider adding a requirement that all medical decisions be made by your family in consultation with a geriatric care manager, Nagaich suggests.

“A geriatric care manager helps your family navigate medical issues,” he explains. “She may be able to select the least expensive and most appropriate help.”

Your attorney or financial planner can recommend someone, he says, or you can find one through the National Association of Professional Geriatric Care Managers.

6. Research long-term care.
Many people are scared of ending life in a long-term care facility. But for people with Alzheimer’s disease, it may be the best option, Caselli says.

“There can be a lot less stress and better quality of life for people with the disease if they’re in a place scientifically designed to deal with a person with Alzheimer’s,” Kessler says.

For example, she says, when someone with Alzheimer’s disease is cared for at home and starts to wander, the response is usually to lock the doors.

“Imagine how frustrating it must be when every door you try to open is locked,” she says. “You don’t have the language to express how you feel, so you tend to act out.”

In the long-term care facility where Kessler worked, “there was one locked door,” she says. “But there were plenty of other doors. People were able to walk off their stress.”

When planning for retirement, consider a complex for seniors with a “step-up” facility that offers more services, such as skilled nursing or memory care. This allows you to choose where you’ll be cared for.

If you’re not ready for that, it’s still a good idea to know which facilities are available in your area, and how you’ll pay for them, if needed.

7. Get tested.
Even though detecting Alzheimer’s disease early won’t stop it, medications can delay worsening of symptoms for 6-12 months, according to the Alzheimer’s Association.

But “it’s better to be diagnosed early,” Caselli says. “We can’t slow the progression of a brain disorder, but we can help you make plans. You can avoid all kinds of problems: taking medications the wrong way, driving when it’s not safe.”

If you’re concerned, start by visiting your family physician, who may refer you to a neurologist, psychologist, or psychiatrist for further testing. Alzheimer’s research hasn’t come up with a single test, but your doctor can perform a variety of different ones.

According to the Alzheimer’s Association, these tests combined can diagnose Alzheimer’s disease with 90% accuracy:
• Analysis of your complete medical history
• Tests of your mental status. These will include a mini-mental state exam (MMSE), which is a series of questions designed to test everyday mental skills, and a mini-cog, which tests cognitive skills such as memory.
• A complete physical and neurological examination
• Blood tests and brain imaging to rule out other conditions
.

How Much Do You Know About Alzheimer's Diease?
More than 5 million Americans have Alzheimer’s disease, and that number could climb to 16 million by 2050. Women face a higher risk of developing it than men, and are also more likely to become caregivers.


By Ellen Wlody, Special to Lifescript
Published June 05, 2011
Reviewed By Edward C. Geehr, M.D.