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Eating Lots of Carbs, Sugar May Raise Risk of Cognitive Impairment, Mayo Clinic Study Finds

Those 70-Plus Who Ate Food High In Fat And Protein Fared Better Cognitively, Research Showed

That’s it. That’s the title of an article recently in posted on the Mayo Clinic website on October 16. It doesn’t get much more Paleo than that.

The study by Mayo Clinic epidemiologist Rosebud Roberts, M.B., Ch.B. and colleagues was published in January 12, 2012 in the Journal of Alzheimer’s Disease. While the type of carbs is not listed in the abstract, carbs in the typical U.S. diet are mostly grains and added sugars.

“Those who reported the highest carbohydrate intake at the beginning of the study were 1.9 times likelier to develop mild cognitive impairment than those with the lowest intake of carbohydrates. Participants with the highest sugar intake were 1.5 times likelier to experience mild cognitive impairment than those with the lowest levels.”

“But those whose diets were highest in fat — compared to the lowest — were 42 percent less likely to face cognitive impairment, and those who had the highest intake of protein had a reduced risk of 21 percent.”

“When total fat and protein intake were taken into account, people with the highest carbohydrate intake were 3.6 times likelier to develop mild cognitive impairment.”

The conclusion from the abstract:

“A dietary pattern with relatively high caloric intake from carbohydrates and low caloric intake from fat and proteins may increase the risk of MCI or dementia in elderly persons.”

Bottom line: More evidence Paleo nutrition sustains brain health. More evidence the low-fat advice is mistaken.

Reference

J Alzheimers Dis. 2012 Jan 1;32(2):329-39. doi: 10.3233/JAD-2012-120862.
Relative intake of macronutrients impacts risk of mild cognitive impairment or dementia.

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The leaves are falling, there is a brisk feel to the air, and the clocks are falling back to daylight savings time. These are sure signs of fall and the winter months to follow. Most people dread the short cold winter days and long nights. However, this is the time of year that it is imperative that you stay healthy. Unlike the bears who hibernate during winter, humans need to step up thoughts of good nutrition and exercise. The most common geographic areas that SAD is prevalent are the upper north where there are limited hours of sunshine.

Seasonal Affective Disorder  (SAD) affects up to 9% of the US population. This is a disorder that is commonly triggered by falling temperatures and lack of sunshine during the winter months. Most persons who are affected by SAD have no symptoms during the spring or summer months when there is more daylight and outdoor activities are abundant.

Some of the symptoms of SAD include depression, excessive sleeping, lack of energy, weight gain, fatigue and difficulty concentrating. The symptoms can come and go, but are more noticeable during times when the daylight is shortest (typically December and January).  Some persons who suffer from SAD may require counseling or hospitalization if the symptoms become severe.

There are several treatments for SAD- but if the symptoms become severe, or thoughts of suicide arise, the person should seek medical attention immediately.

Some suggestions for preventing and helping persons experiencing SAD:

  • Outdoor activity — get outside and participate in physical activity. Go for a walk at lunchtime when the sun is typically the brightest. Participate in outdoor winter sports, such as snowshoeing, skiing, ice skating or sledding. Raking leaves in the sunshine is a great activity, and will also help to keep the weight off. Any physical activity that is in the sunshine will help.
  • If you cannot get out in the sunshine, some people benefit from full spectrum light therapy. This is a special light that can be found in many stores and set up in the home or office. Although full spectrum light does not take the place of sunshine, it is much more effective that a typical light bulb.
  • Good nutrition- Weight gain is very common during the winter months. This is a time that focus on healthy nutrition is essential. Try to avoid processed foods (chips, snacks) and foods containing gluten (breads, cookies, cake, etc).  Focus on lean meats (chicken, fish, pork, beef, etc), vegetables, fruits, and nuts (unless allergic). Fill the plate with steamed vegetables and lean protein.  Avoid high fat, high calorie deserts (such as pie, cake and cookies) and treat yourself to fresh fruit instead. A small serving of high quality dark chocolate has antioxidants that can actually help mood.
  • If the symptoms of SAD become out of control, the advice of a health care professional is necessary. Don’t be afraid to talk with your health care provider about your symptoms- we are here to help!

With Thanksgiving fast approaching, many people are looking forward to a big turkey dinner with all of the ‘fixins’. But, how healthy is that dinner? And what are some healthier alternatives?

  • TURKEY- is a great source of high protein (along with fish and eggs) that is low in calories. Roast turkey is also low in cholesterol thereby making it a great choice for heart-healthy diet. Turkey is low in carbohydrate, thus improving the stability of insulin production after a meal. Roasting the turkey is much healthier that frying—which increases the cholesterol content significantly. Choosing white meat (such as the turkey breast) is healthier than red portions (such as thigh or wing).  Some people are concerned about the amount of tryptophan found in turkey. Tryptophan is an amino acid that is similar to Melatonin, and often helps people sleep.  Research has shown that the amount of tryptophan in turkey is actually no greater than that found in foods such as chicken, tuna or other meats. People who blame sleepiness after a large turkey dinner should consider that other foods that accompany turkey might be the culprit.
  • Dressing or stuffing—this is probably one of the highest calorie and fat options on the table. One single serving (one cup) of regular bread dressing has over 350 calories, 17 grams of fat and almost no protein—and that is just 1 cup!! In addition, stuffing is loaded with gluten, which has been shown to cause inflammation in the system. As an alternative, try fruit and nut “stuffing” – its both delicious and looks beautiful. Another option would be cauliflower rice or mashed cauliflower- the recipe can be found at http://paleoterran.squarespace.com/journal/2011/10/12/eat-this.html
  • Bread or biscuits—another high calorie, gluten rich side dish that can be avoided. Instead of bread or biscuits, how about substituting a rice cake? If you just have to have bread, reach for the gluten-free type.  Or you can just eliminate this side altogether and add another vegetable.
  • Cranberries—oh yes, that yummy side dish that may not be as bad as you thought! If you serve cranberries from a can, keep in mind that it is loaded with sugar and calories. Think about substituting fresh or dried instead of canned. Fresh cranberries are a wonderful addition to almost any table, and are one of the highest berries in antioxidants. Research has shown that fresh cranberries help reduce the incidence of urinary tract infections, help people with gum disease and help to reduce stomach ulcer formation. Fresh cranberries also contain Flavinoids which can help prevent heart disease. With zero fat and only 51 calories per cup, cranberries are a great choice!
  • Vegetables—almost any vegetable is suitable with turkey. Try steamed carrots, green beans or peas instead of canned. 2/3 of the dinner plate should be filled with vegetables. Also try fresh veggies as a side- such as celery hearts filled with hummus.
  • Desert—ok, everyone loves desert after a great meal… but think about some healthy choices. A small slice of pumpkin pie has over 300 calories and over 15 grams of fat—and that does not include the whipped topping!!  Instead, choose fresh sliced apples, sliced kiwi or a fruit salad. For a real treat, try high quality dark chocolate- which has antioxidants galore!
  • And after that big meal… go outside for a walk! Play ball with the kids or walk the dog. About 30 minutes of exercise will help digestion and ward off the feeling of bloating and tiredness.

 Start a few new traditions

  • Instead of cooking a big meal, volunteer you and your family to serve at the local soup kitchen
  • Take a meal to a shut-in or elderly person who lives alone
  • Offer to drive your elderly neighbor to church or a family gathering
  • Volunteer at your local nursing home to visit with the residents
  • Join a group of carolers at the local children’s hospital or nursing home
  • Volunteer at the local food bank
  • Take the money you would spend on a big meal and purchase a few coats/hats/gloves for the needy
  • Adopt a family – there are many families who do not have any food to eat

 “For each new morning with its light,
For rest and shelter of the night,
For health and food,
For love and friends,
For everything Thy goodness sends”

Ralph Waldo Emerson (1803-1882).

 

Cerebral Aneurysms

Cerebral aneurysms are a weakness in the blood vessel’s wall that leads to a small focal dilation.  The etiology is debated, but they most probably start as a congenital wall weakness and later enlarge and dilate; changing size and morphology as we age.  The true prevalence of aneurysms in the general population is difficult to predict, but a reasonable estimate is ~5%.  15-20% of patients with an aneurysm will actually have multiple aneurysms.  Risk factors over time for aneurysmal enlargement include older age, smoking, hypertension, atherosclerosis, amphetamine use, head injury, heavy alcohol consumption, blood infections, and low estrogen after menopause.  Congenital risk factors include connective tissue disorders, polycystic kidney disease, coarctation of the aorta, and family history of aneurysms.  Aneurysms also have been found to occur in predictable locations such as branches off blood vessels.  Anterior communicating artery and posterior communicating artery aneurysms are the most common.

Aneurysms may either be identified after rupture (usually presenting as a subarachnoid hemorrhage or intracerebral hemorrhage), after surveillance imaging for a new neurologic deficit or headaches, or incidentally on imaging for an unrelated issue.  Ruptured aneurysms are the most common cause of spontaneous subarachnoid hemorrhage.  Usually the aneurysm temporarily thromboses following the initial bleed, however re-hemorrhage may occur.  The initial treatment for subarachnoid hemorrhage is to stabilize the patient in an intensive care unit followed by surgical treatment of the aneurysm.

A noncontrast computed tomography (CT) scan is useful in determining if a subarachnoid hemorrhage has occurred and may identify larger aneurysms.  If the clinical findings suggest a bleed but the CT scan appears negative, a lumbar puncture may be performed to identify red blood cells or xanthrochromia in the cerebral spinal fluid.  If an aneurysm is suspected, ruptured or unruptured, a CT angiogram or magnetic resonance angiogram are also useful tests to identify possible intracranial aneurysms.  However a dedicated four vessel cerebral angiogram is the gold standard for diagnosis.

Great debate exists as to the treatment of unruptured cerebral aneurysms.  As a result there have been a number of efforts to determine the natural history of aneurysms in relation to morbidity and mortality, patient age, aneurysm size, and aneurysm location.  The International Study of Unruptured Intracranial Aneurysms (ISUIA) was a two part study attempting to evaluate these issues.  Based on size and location, aneurysms smaller than 7mm appear to have a very low risk of rupture and it is not until they are larger than ~13mm that significant risk or rupture exists, unless the aneurysm is in the posterior circulation.  If the aneurysm is a posterior communicating artery aneurysm or in the posterior circulation, aneurysms larger than 7mm pose a fairly significant risk of rupture.  Of course these are not steadfast rules.  Any aneurysm may rupture at any time, and patients should be counseled regarding their specific risk factors for rupture and desire for prophylactic surgery.  A young patient with a 3mm aneurysm who is a smoker has a different risk profile to an older healthy patient with same size aneurysm.  Any patient with an aneurysm should be evaluated by a neurosurgeon.

There have been no identified conservative management strategies for aneurysm treatment other than changing modifiable risk factors.  Surgery is the only definitive treatment.  Surgery may be performed as an open procedure where a metal clip is placed on the aneurysm or as an endovascular procedure where small metal coils are placed inside the aneurysm.  In either strategy, the aneurysm dome is blocked so that blood cannot enter and the vessel wall repairs with time.  There are advantages and disadvantages to either procedure.  A large study called the International Subarachnoid Aneurysm Trial (ISAT) was reported in 2002 to compare the two treatments.  It appears that either treatment may successfully treat aneurysms.  However, the aneurysm location, morphology, and patient preference are the key features that should determine whether an aneurysm is microsurgically clipped or endovascularily coiled.

For and evaluation please call The Neurosurgery Center of Colorado at 303-481-0035 and make an appointment with Adam P. Smith, MD.

 

After a thorough evaluation, and diagnostic tests as indicated, treatments should begin with the least invasive (conservative) and progress to more invasive, depending on the individual.

  • The first line of treatment may be an exercise program focused on muscle strengthening and range of motion. This is generally directed by a physical therapist.  Some people may benefit from cervical traction (device that uses a small halter attached to a weight) under the guidance of a physical therapist.
  • Work and activity modifications may be helpful, especially for those who have jobs that involve heavy labor.  Bedrest is not generally recommended, and may make the pain worse. Adjusting chair/desk height, computer station adjustments, or other ergonomic considerations may also help with the pain for those who work primarily at desk type jobs.
  • Alternating ice and heat to the neck can be helpful if the pain is triggered by certain activities. Caution should be used when using an electric heating pad or microwave heat wraps, as these can result in significant skin burns. A good rule of thumb is to set a timer to 15 minutes, and alternate ice, then heat.
  • Medications such as NSAIDs (ibuprofen, Aleve, naproxen), and muscle relaxers can be very beneficial. Chronic use of narcotics is generally not indicated, as this can lead to dependency. Some people can benefit from other types of medications prescribed by a provider.
  • Injections of steroids (Epidural steroid injection) or local anesthetic blocks can often help with nerve type pain that originates from pressure on the nerves in the neck. Although the injection does not cure the disc degeneration, or slow the arthritis process, injections can help by providing temporary pain relief. In some cases the effects of the injection can last for many months.
  • Occipital nerve blocks: If the pain is from pressure on the occipital nerve, a specific block in the nerve can result in considerable relief. Sometimes, a nerve block is used as both a therapeutic (help the pain), as well as a diagnostic test (if the pain is helped by the block, there may be a better understanding that this is the source of the pain). If the patient has very good relief of the pain from a block, a nerve root ablation (“burning” the nerve) may be a more permanent solution.
  • Surgery- when other less invasive treatments have failed, some people may need cervical surgery. The type of surgery is based on the neurologic examination and the findings on the imaging studies.

If you think you have CERVICOGENIC HEADACHE, one of the providers at the

Neurosurgery Center of Colorado may be able to help- call today for an appointment.

There are many risk factors for developing Cervicogenic Headache. Many are factors that you can control, such as smoking, poor posture, exercise and rest.

Some tips for healthy neck habits:

  • Smoking and the use of tobacco products can significantly accelerate the rate of drying out of the discs. If you smoke, either quit or begin a smoking cessation program as soon as possible.
  • Get plenty of rest at night, as a good night’s sleep can help with muscle tension in the neck. Place a pillow under the head when lying flat.
  • Some people benefit from a special pillow (cervical pillow) that is curved on the edges to give the neck additional support
  • If you notice that you have neck pain when looking down (at the computer/paperwork/books) for long periods, explore a different height of the computer or chair that you use. Raise the height of your work such that you are looking straight ahead.
  • Maintain good posture while sitting or walking
  • Do not “pop” your neck or allow anyone else to
  • Move frequently- if you have a job that requires long periods of time in one position, stand up and do stretches, or relax the shoulders and gently rotate your head back and forth.
  • Exercise daily- walking is a good way to stretch the muscles,  maintain healthy weight and reduce stress
  • If you note pain that progressively gets worse, or if there is pain/numbness/tingling that radiates down the arm, or if you notice weakness in the hands or arms, consult your primary care provider.

Check back next week for common treatment options for Cervicogenic Headache!

The causes of cervicogenic headache are varied and typically depend on the problem in the structure of the neck. Various causes are described below:

  • Degenerative changes: The most common cause of cervicogenic headache is degenerative change (arthritis) in the neck (cervical spine). These are natural aging changes that cause bony spur formation, pressure on the nerves, and laxity/hardening of the ligaments.
  • Kyhposis (reversal of cervical curvature): The neck normally has a gentle C-shaped curve (lordosis) that allows the neck to curve slightly backwards. This normal position keeps the head in balance and reduces neck strain. As our discs dry out, they lose some of their height , resulting in straightening of the neck neck.  In some cases, the neck angles forward instead of backward. This causes greater strain on the muscles at the back of the neck, and results in occipital headache.
  • Whiplash: This is an injury that occurs from the head being “whipped” back/forth quickly. The mechanism of injury is from the head moving in a flexion/extension motion. The most common type of Whiplash injury is due to motor vehicle crash or contact sports injury (such as football or soccer). Headaches following whiplash are very common and have been reported in 80% of persons at 2 months following whiplash injury. Even 2 years after a whiplash injury, 20-25% of persons will still have headaches
  • Nerve compression: A common cause of nerve compression is degenerative disc disease, or arthritis in the neck. As the spine ages, and the discs lose their height, the small joints on the sides become more narrow. The nerves then have less room to travel through the joint, resulting in pressure on specific nerves. Another cause can be from a herniated disc in the neck that causes pressure on a specific nerve. Less commonly, nerve compression may be due to other causes such as tumors or abnormal fluid cavities in the spinal cord.

Tune in next week  to read about the risk factors for causing CERVICOGENIC HEADACHE.

Cervicogenic headache is a common type of head pain that occurs in approximately 2.5% of the U.S. population. Occipital (back of the head) headaches generally occur from problems in the neck, especially the upper part of the neck. The pain originates in the neck, but it can radiate up to the head and cause head pain- called cervicogenic headache.

The headache usually radiates from the neck to the occipital area (back of the head), to the temples, or around the eyes. It can be on one side of the head (unilateral) or both sides (bilateral). The pain is often described as dull, aching, and is aggravated with head/neck movement. Poor posture, looking up, or looking down for long periods of time can trigger or worsen the head pain. Some people who have desk jobs or look up or down for long periods of time can have cervicogenic headache. Generalized muscle tension can also result in headaches that radiate from the neck up to the head.

The pain of cervicogenic headache can be due to problems in the neck, such as cervical discs disease, facet joint degeneration (arthritis), ligaments that become less stretchy, or from muscle spasm. The pain can come from any area of the neck, but commonly originates from the upper (C2-3, C3-4) joints or discs.  Pain can also occur from unstable areas in the upper two joints (atlanto-occipital and atlanto-axial joints), and is called “atlanto-axial instability”.

For causes of cervicogenic headache, please check back next week for part II.

Peripheral nerve disorders comprise a wide variety of pathologies.  Most prevalent are compressive entrapments, with carpal tunnel syndrome and cubital tunnel syndrome being some of the most common.  A peripheral nerve may be compressed at any point from where the nerve roots exit the spinal cord to their insertion into muscles.  However, common points of compression exist.  The key in diagnosing entrapment location is knowing the innervation patterns of each nerve, the common points of entrapment, and classic clinical signs and examination findings.

The median nerve supplies motor innervation to most of the forearm flexors and a few intrinsic hand muscles.  It supplies sensory innervation to the palmar surface of the thumb, index finger, middle finger, and part of the ring finger.  Compression of this nerve most commonly occurs in the wrist underneath the transverse carpal ligament.  The etiology is controversial but probably is caused by a combination of structural, genetic, and repetitive hand use factors.  Certain diseases such as hypothyroidism, acromegaly, amyloid, and diabetes can also lead to compression.  Symptoms of entrapment are mainly numbness, paresthesias, and pain.  Numbness and paresthesias are experienced in the sensory distribution of the nerve.  Generalized palmar numbness is not carpal tunnel syndrome, but may represent compression of the median nerve elsewhere.  Numbness usually occurs during sleep (due to a flexed wrist posture).  Pain may also occur in the nerve’s sensory distribution.  Weakness may be present, but almost always occurs following chronic entrapment.  Sensory changes always precede motor changes and are more sensitive for diagnosis.  Atrophy of the muscles between the thumb and index finger (thenar atrophy) may be present as well.

The ulnar nerve supplies motor innervation to one and a half forearm flexors and most of the intrinsic hand muscles.  It supplies sensory innervation to the palmar surface of part of the ring and entire pinky finger.  Compression of this nerve most commonly occurs in the elbow.  The ulnar nerve passes from the upper arm into the forearm just medial to the olecrenon of the ulna in the postcondylar groove.  It then passes between and under muscles to enter the forearm.  This is called the cubital tunnel.  The etiology of compression is usually trauma or arthritis in the elbow (tardy ulnar palsy).  Symptoms usually insidiously present as paresthesias in part of the ring and pinky fingers.  Weakness of the hand intrinsics may occur at the same time or even as the sole presenting finding.  With chronic compression, classic signs may develop such as Froment’s sign, Wartenberg’s sign, or hand clawing.  Hypothenar atrophy may also be present.

When entrapment is suspected, nerve conduction studies and electromyography are useful in validating the degree of injury and location, but clinical exam findings are the key to diagnosis.  The general distribution of clinical symptoms will identify which nerve (ie. ulnar, median, radial, etc.) is involved.  But the exact location of compression is more difficult to decipher.  Detailed testing of sensory deficits and key motor groups are crucial steps.  As branches exit off each main nerve at different points, isolative testing of individual muscles will determine, for example, if compression of the ulnar nerve is in the cubital tunnel of the elbow or Guyon’s canal in the wrist.  However, more common and classic examination maneuvers may be useful as well.  For both median and ulnar compression, tapping the wrist or elbow (Tinel’s sign) may reproduce the sensory complaints.  This is positive in ~60% of cases.  Using the contralateral extremity as a control helps to validate results.  For median nerve compression, flexing the wrists and opposing them (Phalen’s sign) may also reproduce the symptoms and is positive ~80% of the time.  For ulnar nerve compression, Froment’s sign may be seen by having the patient grasp a piece of paper between the thumb and index finger pads.  Pulling the paper will cause the patient to use the tip of the thumb instead, as the flexor pollicis longus substitutes for the weak adductor pollicis.  Wartenberg’s sign is characterized by an abducted pinky finger caused by weakness of the interosseous muscles.  Patients may complain that their pinky finger gets caught as they place their hands in their pockets.  A claw hand deformity may also be present.

Treatment of both carpal tunnel and cubital tunnel syndromes usually starts with conservative therapy.  Carpal tunnel syndrome commonly resolves with rest, NSAIDs, wrist splinting, and steroid injections.  Cubital tunnel syndrome is treated by avoiding any activities that exacerbate compression (such as repetitive extreme elbow flexion or resting the elbow on hard surfaces), protective elbow sleeves, splinting, and steroid injections.  Patients whose symptoms progress, despite conservative measures, and those who present with weakness, muscle atrophy, or significant denervation on nerve conduction studies should be considered for surgical treatment.

Carpal tunnel syndrome is surgically treated by making a small incision over the wrist and proximal palm and transecting the transverse carpal ligament.  This procedure may be performed using minimal sedation or a nerve block, and patients commonly go home the same day.  Cubital tunnel syndrome is a more involved procedure requiring the patient to undergo general anesthesia.  An incision is made over the medial elbow and the muscles and ligaments over the nerve are either decompressed or the nerve itself is transposed underneath forearm muscles to relieve compression.  Patients are still able to go home the same day.

For an evaluation or possible surgical treatment of peripheral nerve entrapment, please call The Neurosurgery Center of Colorado at 303-481-0035 to make an appointment with Dr. Adam P. Smith, MD.

Watermelon is a fruit that originated in South Africa. Originally, watermelon was a wild type of fruit plant, but the species has been cultivated and spread throughout the world. There are about 1200 species of watermelon grown today. The largest producer of watermelon is China. Watermelon contains about 92% water (hence the name) and very low fat. There is a large sugar component (about 6.2 grams per slice), so people who are diabetic or glucose intolerant need to be careful eating large quantities. Watermelon is a good source of Vitamin C and Lycopene. For those people trying to lose weight, watermelon should be on the menu as it contains fiber and a natural diuretic. Try substituting a cold slice of watermelon for desert or a snack.