Wellness - Wellcast

So If It’s Not Alzheimer’s, Then What Is It?

April 11, 2023 By Deborah

Many older Americans expect to lose brain function but most don’t ask their doctors about preventing dementia. Walking into a room and then forgetting why you are there. Or unable to recall names of old TV shows or long-lost friends or classmates. Even though these instances can be a normal sign of aging, if they become more frequent or escalate, then it’s time to evaluate other causes. In reality, research suggests that less than 20% of people who have reached age 65 will go on to lose cognitive ability from Alzheimer’s disease, vascular dementia or other conditions. So if it’s not Alzheimer’s, then what is it? It could be something known as mild cognitive impairment. Mild cognitive impairment (MCI) is an early stage of memory loss in people who are still independent.

For people diagnosed with MCI, there are some screening tests worth doing. Screening includes: Checking thyroid and other hormone levels and B12 as well as other markers of inflammation. Ruling out sleep apnea and ADHD are important screening tests but are commonly forgotten. ADHD is a conditon which a person may have had all their lives but is more pronounced since entering menopause. Also, screening for depression and looking for side effects of certain medications are essential in looking for answers.

If symptoms are more related to feeling overwhelmed, forgetful, lack of concentration and difficulty prioritizing, then consider getting screened for ADHD (attention deficit hyperactivity disorder). It is a neuropsychiatric disorder that starts in childhood and and continues throughout life. Three quarters of adults 18 to 44 who are diagnosed with ADHD were never diagnosed as children. For adults 60 and older, that’s 100% according to Dr. David Goodman, assistant professor of psychiatry and behavior sciences at the Johns Hopkins University School of Medicine. The reason is that half a century ago, practitioners simply didn’t know how to screen for it in children.

When a woman reaches menopause or the stretch of time before her last menstrual period (peri-menopause), the symptoms of ADHD can be significantly worse. The drop in estrogen (which is very protective for the brain) can make hyperactivity, distractibility, executive function challenges, including time management and impulse control more difficult. This means coping methods that you may have relied on no longer work. Lowered estrogen levels affect short-term memory and the ability to focus. Many women complain of “brain fog”. These lowered estrogen levels in women may also not allow ADHD stimulants to work effectively. This is more of a problem for women than men since testosterone seems to have no effect on either the impairments of ADHD or the effects of ADHD medications in men.

Only 1 in 5 memory disorder clinics actively screen for ADHD. People can have ADHD all their lives and now they are developing dementia. Now you have 2 processes contributing to cognitive difficulty.

Menopausal women experiencing cognitive decline should be screened for ADHD. If ADHD is positive, then behavior strategies, counseling and medication should be considered. Stimulants such as Ritalin, Adderall, and Vyvanse are typically used to treat ADHD in young people. Many doctors have been trained to avoid these meds due to their risk of high blood pressure and other cardiovascular problems. The studies are mixed and a 2020 review in the Journal of the American College of Cardiology found a link between stimulant use and modest elevation of heart rate and blood pressure. But according to Dr. Bill Dodson, a Denver psychiatrist who specializes in adults with ADHD, “the effects observed were minuscule and of no clinical significance”.

Clinical trials from the 2002 Women’s Health initiative have cast a shadow on the safety of hormone replacement therapy. Subsequent evaluations have found the dangers of HRT to be overstated, while the health risks of low estrogen are well established. For more, check out What you need to know about hormone replacement therapy

There are ways to manage your symptoms. See a practitioner and express your concerns so biological markers can be ruled out and screening tests can be performed. Not all slowing cognition at middle age is due to a medical reason. Stress management and good support can make a significant difference in our lives. People with ADHD have a tendency to overcommit. When you feel overwhelmed, that is a sign you need to simplify. There are ADHD coaches and support groups that can help. CHADD.org is an educational and advocacy nonprofit that offers a network of regional support groups.

References: Macmillan, C. Mild Cognitive Impairment: It’s Not “Normal” Aging. Yalemedicine.org. Doctors & Advice, Family Medicine. June 6,2022.

Barger, T. Attention, Please! If memory and focus problems are placing you at midlife, it could be undiagnosed ADHD. Here’s how to tell. AARP Bulletin Dec 2022. pp. 20-21

Postbiotics is Part of the Gut-Brain Axis

March 25, 2023 By Deborah

We have heard the term “probiotics” which refers to the live bacteria and yeast that help maintain or improve the healthy microflora in the gut. We may also be familiar with “prebiotics” which are the fermented foods that FEED these amazing bacteria, as well as viruses and yeast species. But postbiotics are also part of the gut-brain axis that needs to be discussed. All three of these types of “biotics” (from the Greek “bios” meaning “for life”) should be part of the discussion when it comes to our gut, which is the largest organ in the body that holds 70% of our immune system. So it needs to be happy, healthy and well cared for.

So what are “postbiotics’? They are defined as the nonviable bacterial or metabolic products from microorganisms that have biological activity in the host. It is basically the waste left behind by the digestion of pre and probiotics. Some postbiotics from non-viable microorganisms come from Lactobacillus species. These precision probiotics are strains that have precise effects in the body and brain. For instance, there is growing evidence of antidepressant effects of GABA secreted by Lacticaseibacillus rhamnosus and Lacticaseibacillus casei that travels through the nervous system and crosses the blood-brain-barrier altering the expression of GABA receptors that may lead to a reduction in depression. Another GABA secreting bacteria, Levilactobacillus brevis may help with sleep as well as reducing depression.

The fact is that we make more neurotransmitters in our gut than the brain. Certain bacteria can send serotonin, GABA, dopamine and norepinephrine to the brain. Postbiotics are especially helpful in people who are sensitive to probiotics, because they are less likely to cause gas and bloating. It also helps those whom are immune compromised as they pose no risk for infection.

As I mentioned before, postbiotics can include inactivated probiotics or cell wall fragments. This includes metabolites such as short chain fatty acids (SCFA), vitamins (folate, B12, Vitamin K), enzymes and bacterial lysates and more. The most common postbiotics from nonviable organisms come from lactobacillus species, Bifidobacterium species and Saccharomyces (yeast) and bacillus species. The SCFA’s, primarily sodium butyrate are fuel for the microbiota and help regulate GI function, blood pressure and act as intermediaries between the gut and the brain.

Postbiotics have many functions: they strengthen the tight junctions in the gut, improve leaky gut, help with immune modulation, protect from infection and mitigating allergies.

They also help support healthy metabolism by lowering the risk of insulin resistance and the regulation of hemoglobin A1c (blood sugar levels). More and more human studies are being conducted and have observed improvements in irritable bowel syndrome symptoms, immune support (reducing risk of upper respiratory infections and less allergic symptoms), and metabolic support by lowering systolic blood pressure and decreasing elevated liver enzymes as well as total cholesterol and LDL.

Postbiotics are an important addition to gut-brain therapeutics. More research is needed but the existing studies show that dosing varies according to the specific postbiotic and the conditions being used to treat. They are effective in supporting the gut and building foundational health from the gut up.

References: Fidler, M. “Postbiotics: The newest addition to gut-brain therapeutics”. Element by Emerson Ecologics. Issue #6 p. 30-33. 2022.

Lowry, C. “Understanding the Gut Brain: Stress, Appetite, Digestion and Mood”. Conference in Lafayette CO. 3/13/2023.

Golen, T. “What are Postbiotics?” Harvard Health Publishing: Harvard Medical School. Nov. 1 2021.

What You Need To Know About Hormone Replacement Therapy

February 12, 2023 By Deborah

More than 1 million women in the United States experience menopause each year. Yet we are still in the dark about what to do about the troublesome symptoms that embrace this phase of life. Those symptoms can vary for each woman but primarily consist of intrusive hot flushes and night sweats with many hours of lost sleep. Low energy and mood changes that can disrupt work and relationships. Brain fog and difficulty grasping words which cause anxiety around the question of whether you are entering the beginning stages of Alzheimer’s disease. Then there’s the weight gain (especially in the mid-section) along with hair loss, dry skin, dry nails and eyes. The worst part is the fact that these symptoms begin 6 months to 12 years leading up to a woman’s last period, known as peri-menopause. This starts when women reach their late 40’s due to hormonal spikes and dips of estrogen and progesterone as the last eggs of the ovaries start to plummet in number. Irregular menstrual bleeding can also accompany these other symptoms making this time in a women’s life unpredictable. This presents confusion about where to turn for answers and options to get their lives back. Here is what you need to know about hormone replacement therapy (HRT).

Hormone replacement therapy has been around for many years (since 1942) until it took a dramatic turn. The prescriptions for hormone therapy, which was once the most commonly prescribed treatment in the United States suddenly dropped due to a 2002 poorly designed study finding links between hormone therapy and elevated health risks for women of all ages. This single study did women a disservice in how it generalized the use of HRT as opposed to what the study really was about- the unsafe and one-size-fits-all synthetic oral hormone, Prempro. The reasonable thing to do for women who were taking Prempro was to contact their gynecologist and yes, stop that form of HRT but to then discuss other hormone options. But instead, women flushed their pills down the toilet and never looked back. The message was “Hormones are Dangerous”.

It has been a disgrace to see women not even offered the option of HRT when symptoms were quite significant and after they had suffered years of unnecessary discomfort.

Hormone therapy can carry risks as do many other medications that people take to relieve serious symptoms. But dozens of studies since 2002 have provided reassurance for healthy women under the age of 60 or within 10 years of the onset of menopause who are free of contraindications. And the message is that the use of hormone therapy is safe and appropriate. The treatment’s reputation, however has never fully recovered and the consequences have been wide-reaching. It has been a disgrace to see women not even offered the option of HRT when symptoms were quite significant and after they had suffered years of unnecessary discomfort. Instead women are offered a pill for their insomnia, a pill for their depression, a pill for their newly diagnosed osteoporosis, a pill or injection for their diabetes, a pill for their high blood pressure, a pill for achy joints, a pill for their high cholesterol and plaque (caused by endothelial damage). Is it possible that there is a treatment for all these symptoms but has been overlooked by doctors? Yup! And it’s hormone replacement therapy. I am not saying that women would be immune to these conditions if they were on HRT, but it would be significantly less, if at all. This is just another example that reflects the medical culture’s challenges in keeping up with science as well as a representation of a lost opportunity to improve women’s lives.

Rebecca Thurston, a professor of psychiatry at the University of Pittsburgh who studies menopause, believes menopausal women have been underserved- an oversight that she considers one of the great blind spots of medicine. She states “it suggests that we have a high cultural tolerance for women’s suffering. It’s not regarded as important”.

So what does this mean now? Guidelines on hormone therapy from The North American Menopause Society has recently updated their 2022 position statement from 2017. It states that treatment should be individualized using the best available evidence to maximize benefits and minimize risks. Timing is important and the type of hormones are important. The risks of hormone therapy differ depending on type, dose, duration of use, route of administration, timing of initiation and whether a progestogen is used. The benefit-risk ratio appears favorable in lowering the risk of coronary heart disease, stroke, venous thromboembolism osteoporosis, depression and dementia for those that initiate treatment younger than 60 years or who are within 10 years of menopause and have no contraindications. Most women start HRT due to bothersome vasomotor symptoms (hot flushes) and genitourinary symptoms. Longer durations of therapy beyond the age of 65 are for persistent symptoms and women should be a part of the decision-making as periodic evaluation continues.

I still have patients tell me that their doctors insist they go off their HRT because they have been “on it for too long”. Do we say the same thing about a man’s testosterone or Viagra prescriptions?! Both women and their providers became very fearful after the 2002 WHI study. It is time to clarify and reassure women that hormone therapy can be given safely and effectively to relieve women’s symptoms and improve their quality of life as long as they are being monitored and the benefits continue to outweigh the risks. We also know that these hormones can delay or prevent many long-term degenerative diseases that are caused by aging. If women are expected to live on average another 30 years after menopause, let’s at least offer them the best quality of life for the years ahead.

We have come a long way…but we’re still not there. Let’s open up the discussion and allow women to voice their concerns and complaints without shame or guilt on whether their discomforts are “significant” enough. They deserve to ask questions and get reliable answers based on current studies with sound guidelines that we currently have, and not a study that was over 20 years old! More research is always needed to help navigate this topic not only for menopausal women now but for our younger generation of women moving forward.

References: Faubion, S, et al. NAMS Position Statement: The 2022 hormone therapy position statement of The North American Menopause Society. Menopause: The Journal of the North American Menopause Society, Vol 29. N0. 7, pp 767-794.

Dominus, S. Women have been misled about menopause. The New York Times magazine. February 1 2023. pp 1-19.

Kaunitz, A. Guidelines on HT have been updated by The North American Menopause Society. OBG Management. June 2017, Vol. 29, N0. 6. pp 18-23.

https://www.nia.nih.gov. Research explores the impact of menopause on women’s health and aging. May 6, 2022.

4 New Advanced Heart Disease Tools

January 22, 2023 By Deborah

There are some new advanced heart disease tools…and boy do we need them! There are some heart-health trends that are concerning cardiologists. There is a crisis in terms of a lowered life expectancy for the first time in decades according to cardiologist Sadiya Khan, M.D., assistant professor of medicine and of preventative medicine at the Northwestern University Feinberg School of Medicine in Chicago. The lowered life expectancy is due to several reasons: 1) midlife and younger adults are dying of heart diseases more often- death rates rose 8.5% for adults aged 45-64 between 2010-2020. 2) Fatalities due to heart disease for those over the age of 65 also rose significantly with our older population growing. 3) The COVID pandemic fueled the heart disease resurgence. The side effects of the pandemic’s long-term legacy of weight gain, inactivity and stress raised heart attack deaths by 21% for those 45-64 and 17.9% for people over age 65. The virus itself also plays a direct role in how lingering heart risks have been found a year after COVID infection. COVID could emerge as the #1 risk factor for future heart disease. We know a lot about how our lifestyle habits- diet and exercise-can prevent or increase cardiovascular risk. There are 4 new advanced heart disease tools to know and ask your doctor about.

Cleerly- an FDA approved system created by James Min, M.D. for evaluating heart plaque in CCTA (coronary computed tomography angiography) images. The plaque is assigned to a risk stage determining if it is hard stable plaque (good) or soft unstable plaque (not good). Patients can actually view the pictures and see what’s going on inside their own heart. This motivates people to stick with their medications and healthy habits. Cleerly health
Intravascular Lithotripsy is a new technique approved by the FDA in 2021 that uses shock waves to break up hard plaque deposits in vessels (similar to what they use to break up kidney stones). Patients can receive a stent after this procedure that are stronger, safer and more flexible. Biodegradable stents are on the horizon.
Advanced heart drugs: Sodium glucose transporter 2 (SGLT-2) inhibitors have been on the market to treat diabetes. But they really reduce episodes of heart failure in patients with or without diabetes. Studies have shown it can be used to cut the risk of hospitalization or death from heart failure by 33%. The other drug is PCSK9 for those who cannot tolerate or have not seen enough of a therapeutic effect with statins. It is given by injection q 3 or 6 months and lowers LDL cholesterol by 50-60% and also reduces the odds of a heart attack by 20% more than statins alone.
Transcatheter aortic valve replacement (TAVR). Instead of requiring open heart surgery which is deemed too risky for the elderly population (that need it most), the aortic valve can be repaired by implanting a new valve using a catheter that is threaded through the femoral artery. Patients are usually discharged after 1 overnight stay in the hospital.

According to a 2021 report from the American Heart Association, 77.5% of men and 75.4% of women ages 60-79 have some form of cardiovascular disease. Among those of us 80 and older, 90% have it. And by the time women reach their 70’s or 80’s, their risk of heart disease exceeds that of men. I know these statistics sound daunting….but the more we are aware of our own risk factors and have tools to measure our own heart disease, the more we can be proactive in prevention and early treatment.

References: Cleerlyhealth.com

Harrar, S. America’s war against heart disease. AARP Bulletin. Jan/Feb 2023. P 8-16.

6 Steps in Preventing Age-related Macular Degeneration

January 14, 2023 By Deborah

Healthy eye sight is dependent upon our overall well-being, which is dependent upon our genetic make-up, the foods we eat, our activity level, work environment and exposure to airborne toxins. Aging macular degeneration (AMD) is one of many eye diseases that can be slowed down. Although we can’t avoid aging or genetics which are the main causes of AMD, we can control other risk factors and delay or slow the progression of the disease.

AMD occurs when there is damage to the part of the retina known as the macula- which is the part of the eye that controls sharp central vision. When the macula deteriorates, it causes blurred vision. It may affect the ability to drive, to see faces and to read smaller print, but it rarely causes blindness. AMD

Specific habits have been identified in studies to be damaging to eye health. The main risk factors besides age and genetics is smoking, high blood pressure and a diet high in saturated fats and refined processed foods. So how can we prevent vision loss and keep our eyes and bodies strong? Here are 6 steps in preventing age-related macular degeneration:

1. Stop Smoking! Studies have shown that smokers have a 2-3 times higher risk in the development of AMD than non-smokers. A 2015 study found damage and inflammation to several layers of the macula in smokers. Smoking causes high blood pressure which raises pressure in the blood vessels and raises oxidative stress and free radicals.

2. Eat more leafy greens which are rich in carotenoids that your eyes need, especially lutein and zeaxanthin. These particular carotenoids have been shown to be low in people with macular degeneration. Collards, kale and spinach can be added to soups, salads, or pureeing them in smoothies. These nutrients in foods or supplements have been found to prevent and even improve AMD in many cases. Vitamin C can enhance the absorption of lutein.

3. Weight loss (if needed) helps digestion and lowers inflammation which allows for a healthier microbiome. Avoid the typical Western Diet which is high in saturated fats and high fructose corn syrups, sugars and processed foods.

4. Choose healthy fats such as omega-3 fatty acids. Omega-3’s have the ability to regulate formation of extraneous blood vessels that distort vision. Eating fish is a great way to increase omega-3 in your diet. Some people need supplementation and 2 grams daily with food is a good starting place. Vegetarians can choose algae, hemp or krill as good sources.

5. Zinc is necessary for a healthy macula and is found abundant in meats and seafood. It is also in nuts, grains and legumes but is not in a readily absorbable form. Zinc supplementation may be needed for vegetarians and vegans. A RBC Zinc level can determine deficiencies.

6. Vitamin D3 is easy to measure in a blood test. Low levels are associated with increases in macular degeneration symptoms. Vitamin D has anti-inflammatory and anti-angiogenic benefits, especially where genetic risk is greatest. D3 has an important role in the immune system and aging process of AMD and all diseases.

Choose a positive, healthy lifestyle that includes exercise, daily meditations or walks in nature and a healthy diet. It may prevent or slow down the diseases of aging and improve the quality of your life.

References: Grossman, M. Eye disease, integrative vision care, and nutrition. Townsend Letter. April 2022, issue #465, p 42-43.

Age-related Macular Degeneration. https://www.hopkinsmedicine.org/health/conditions-and-diseases/agerelated-macular-degeneration-amd.