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August Newsletter
In This Issue
Modifiable Factors To Reduce Alzheimer's Risk
Add Some Spice To Your Life
Is Your Food Causing the Blues?
A New Model of Medical Care
Dr. Niedfeldt
Old-fashioned medicine with 21st Century convenience and technology
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I hope this newsletter finds you and your family well. It kind of feels like fall this week, not sure I'm ready for that. I hope everyone has a nice Labor Day weekend and gets the chance to connect with family and friends. 


The first article this month looks at Alzheimer's disease, a terrible affliction that touches most of us, either directly or indirectly. There is no cure, but this study found 9 modifiable risk factors that we can focus on in our preventive efforts. 


I like spicy food. The second article shows that my love of spicy food may also help me to live longer (although the time I ate some ghost pepper I thought I took a few years off it). 


Finally, depression is a very common affliction in our society. Could there be a nutritional component to this? Read on to find out. 


Click on the links the the left to check out our web site...

Modifiable Factors to Reduce Alzheimer's Risk
Two-thirds of Alzheimer's cases may stem from nine conditions
Alzheimer's disease is the most common type of dementia with worldwide prevalence increasing. There is no cure so finding modifiable risk factors is the only way to reduce risk of this disease. This study, from the most recent Journal of  Neurology, Neurosurgery & Psychiatry found that up to two-thirds of cases may stem from none conditions including high BMI in midlife, carotid artery disease, hypertension, depression, frailty, being poorly educated, having high levels of homocysteine, smoking (Asians only), and having type 2 diabetes. 
Summary of findings:
  • BACKGROUND: The aetiology of Alzheimer's disease (AD) is believed to involve environmental exposure and genetic susceptibility. The aim of our present systematic review and meta-analysis was to roundly evaluate the association between AD and its modifiable risk factors. 
  • METHODS: We systematically searched PubMed and the Cochrane Database of Systematic Reviews from inception to July 2014, and the references of retrieved relevant articles. We included prospective cohort studies and retrospective case-control studies.  
  • RESULTS: 16,906 articles were identified of which 323 with 93 factors met the inclusion criteria for meta-analysis. Among factors with relatively strong evidence (pooled population >5000) in our meta-analysis, we found grade I evidence for 4 medical exposures (oestrogen, statin, antihypertensive medications and non-steroidal anti-inflammatory drugs therapy) as well as 4 dietary exposures (folate, vitamin E/C and coffee) as protective factors of AD. We found grade I evidence showing that one biochemical exposure (hyperhomocysteine) and one psychological condition (depression) significantly increase risk of developing AD. We also found grade I evidence indicative of complex roles of pre-existing disease (frailty, carotid atherosclerosis, hypertension, low diastolic blood pressure, type 2 diabetes mellitus (Asian population) increasing risk whereas history of arthritis, heart disease, metabolic syndrome and cancer decreasing risk) and lifestyle (low education, high body mass index (BMI) in mid-life and low BMI increasing the risk whereas cognitive activity, current smoking (Western population), light-to-moderate drinking, stress, high BMI in late-life decreasing the risk) in influencing AD risk. We identified no evidence suggestive of significant association with occupational exposures.  
  • CONCLUSIONS: Effective interventions in diet, medications, biochemical exposures, psychological condition, pre-existing disease and lifestyle may decrease new incidence of AD. 
This is a large review of the medical literature on Alzheimer's disease from 1968-2014 and looked at 93 conditions that could affect the disease to determine factors with the potential to offer protection against Alzheimer's disease. From their data, it appears that coffee, vitamins C and E, folate may reduce risk. Medications that may reduce risk include some anti-inflammatory medications, statins, blood pressure medications and estrogen. Interestingly, light to moderate drinkers of alcohol saw their risk drop along with those who were battling other serious diseases such as cancer. But the key was the nine factors that appeared to increase risk by around 66%; high BMI in midlife, carotid artery disease, hypertension, depression, frailty, being poorly educated, having high levels of homocysteine, smoking (Asians only), and having type 2 diabetes. These are the areas that we can really hone in on to hopefully reduce the incidence of this disease. 

Add Some Spice To Your Life
Eating spicy food inversely related to mortality

Spices have been used in cooking likely since the start of time. We don't know the source of the various spices, but medicine has shown that some spices have medicinal effects. Ginger can help with nausea and vomiting which is why your mother probably gave you some ginger ale when you were sick as a child (at least mine did). Capsaicin has been used topically as an anti-inflammatory and pain reliever. Tumeric, the spice in curry has been shown to reduce inflammation. This study looked at the relationship between the intake of spicy foods and mortality. 

Summary of findings      
  • OBJECTIVE:  To examine the associations between the regular consumption of spicy foods and total and cause specific mortality.    
  • DESIGN: Population based prospective cohort study.  
  • SETTING: China Kadoorie Biobank in which participants from 10 geographically diverse areas across China were enrolled between 2004 and 2008.  
  • PARTICIPANTS: 199,293 men and 288,082 women aged 30 to 79 years at baseline after excluding participants with cancer, heart disease, and stroke at baseline.  
  • MAIN EXPOSURE MEASURES: Consumption frequency of spicy foods, self reported once at baseline.
  • MAIN OUTCOME MEASURES: Total and cause specific mortality.
  • RESULTS: During 3,500,004 person years of follow-up between 2004 and 2013 (median 7.2 years), a total of 11,820 men and 8,404 women died. Absolute mortality rates according to spicy food consumption categories were 6.1, 4.4, 4.3, and 5.8 deaths per 1000 person years for participants who ate spicy foods less than once a week, 1 or 2, 3 to 5, and 6 or 7 days a week, respectively. Spicy food consumption showed highly consistent inverse associations with total mortality among both men and women after adjustment for other known or potential risk factors. In the whole cohort, compared with those who ate spicy foods less than once a week, the adjusted hazard ratios for death were 0.90 (95% confidence interval 0.84 to 0.96), 0.86 (0.80 to 0.92), and 0.86 (0.82 to 0.90) for those who ate spicy food 1 or 2, 3 to 5, and 6 or 7 days a week, respectively. Compared with those who ate spicy foods less than once a week, those who consumed spicy foods 6 or 7 days a week showed a 14% relative risk reduction in total mortality. The inverse association between spicy food consumption and total mortality was stronger in those who did not consume alcohol than those who did (P=0.033 for interaction). Inverse associations were also observed for deaths due to cancer, ischemic heart diseases, and respiratory diseases.
  • CONCLUSION: In this large prospective study, the habitual consumption of spicy foods was inversely associated with total and certain cause specific mortality, independent of other risk factors of death.

This study of 512,891 Chinese between the ages of 30-79 over a mean of 7.2 years showed a significant reduction in mortality for those who at more spicy foods (mainly chili peppers). It also found that fresh peppers were better than dried peppers. Sounds like a good reason to add some spice to your life!
Is Your Food Causing the Blues? 
High glycemic index foods linked to increased depression risk
This study, published in the American Journal of Clinical Nutrition, looked at the relationship between dietary glycemic load (added sugars and starch) and depression in 87,618 post-menopausal women initially and 69,854 3 years later. The researchers found significantly higher incidence of depression as intake of added sugars and starch (refined grains) increased. Lower odds of depression were found with higher consumption of vegetables, fruit, fiber and lactose. 
Summary of findings:   
  • Background: The consumption of sweetened beverages, refined foods, and pastries has been shown to be associated with an increased risk of depression in longitudinal studies. However, any influence that refined carbohydrates has on mood could be commensurate with their proportion in the overall diet; studies are therefore needed that measure overall intakes of carbohydrate and sugar, glycemic index (GI), and glycemic load. 
  • Objective: We hypothesized that higher dietary GI and glycemic load would be associated with greater odds of the prevalence and incidence of depression.
  • Design: This was a prospective cohort study to investigate the relations between dietary GI, glycemic load, and other carbohydrate measures (added sugars, total sugars, glucose, sucrose, lactose, fructose, starch, carbohydrate) and depression in postmenopausal women who participated in the Women's Health Initiative Observational Study at baseline between 1994 and 1998 (n = 87,618) and at the 3-y follow-up (n = 69,954).  
  • Results: We found a progressively higher dietary GI to be associated with increasing odds of incident depression in fully adjusted models (OR for the fifth compared with first quintile: 1.22; 95% CI: 1.09, 1.37), with the trend being statistically significant (P = 0.0032). Progressively higher consumption of dietary added sugars was also associated with increasing odds of incident depression (OR for the fifth compared with first quintile: 1.23; 95% CI: 1.07, 1.41; P-trend = 0.0029). Higher consumption of lactose, fiber, nonjuice fruit, and vegetables was significantly associated with lower odds of incident depression, and nonwhole/refined grain consumption was associated with increased odds of depression.  
  • Conclusions: The results from this study suggest that high-GI diets could be a risk factor for depression in postmenopausal women. Randomized trials should be undertaken to examine the question of whether diets rich in low-GI foods could serve as treatments and primary preventive measures for depression in postmenopausal women. The Women's Health Initiative was registered at as NCT00000611.               
It may get old to keep hearing me say this, but this study again shows that sugar and starches are bad for you. The more you eat, the more depressed you get (at least if you are a postmenopausal woman). There is no reason not to believe that there are similar effects in all of us. What lowers our risk of depression? Vegetables and fruit, fiber lower the risk. It would be interesting to see a study that used diet to treat depression. I suspect that it would have some very interesting outcomes. So eat some spicy vegetables. You'll live longer and stay happy!
Thank you for taking the time to read through this newsletter. I hope you have found this information useful as we work together to optimize your health. 


The fight against Alzheimer's continues. I hope that we will continue to gather evidence of things that can be done to prevent this terrible affliction. For now, we know some of the things we can work on to reduce our risks. 


Add some spice to your life, you might live longer!


I am a big proponent of a low sugar and starch diet. More and more research is showing how much of an effect our diet can have on chronic disease, but even our mood. Yet another reason to cut out the sugar.


As always, if you have questions about anything in this newsletter or have topics you would like me to address, please feel free to contact me by email, phone, or just stop by! 

To Your Good Health,
Mark Niedfeldt, M.D.