Originally featured in the September 2014 issue of IHCAN magazine.
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One in five people in Great Britain will be aged 65 and over by 2020, and the over-50s are historically the heaviest users of alternative health approaches. IHCAN editor Simon Martin reviews what we can do for our more “senior” clients.
Britain is ageing fast. Even London, with more under-35s than anywhere else in the country, is preparing to deal with massive increases in numbers of not just over-65s, but over-80s.
Our ageing clients are well aware that the NHS is ill-equipped to deal with them and that at the first sign of frailty they may be packed off to a nursing home – what an older friend calls “warehousing”. The final straw is often a fall that results in a fracture.
The intelligent over-50s are already starting to work on their health and represent a growing market for IHCAN practitioners. But their prime concerns are not what we think they are.
Among adults over 50, for instance, “staying mentally sharp” outranks social security and physical health as the top priority and concern, according to a 2013 market review.(2) Behind mental sharpness, of course, lies the spectre of dementia. Results of a Saga poll on Facebook released last month revealed that the over-50s are far more worried about dementia than cancer.(3)
When 500 adults aged over 50 from across the UK were asked which condition they feared the most, 68% said dementia and just 9.5% said cancer.
So more than two-thirds of our over-50 clients are likely to be concerned about dementia, compared with one in ten concerned about cancer: not at all what you’d expect.
Saga runs a monthly poll of 10,000 over-50s and also asks the occasional question on its Facebook page. This one had about 500 responses – “about 3 times more than normally participate in the Facebook questions”, said Paul Green, Saga’s director of communications, “and we were somewhat taken aback by the overwhelming score for dementia – clearly struck a chord.”
Also surprisingly, in this over-50s survey, only around 4% said they were scared of getting a heart condition, and fewer than 1% were concerned about diabetes.
While this may not reflect “real” mortality stats, Bournemouth University’s Prof Colin Pritchard (see box, right) has highlighted an “alarming ‘hidden epidemic’ of rises in neurological deaths”, especially in the UK. “It is NOT that we have more old people, but rather more old people have more brain disease than ever before, including Alzheimer’s.” On top of that, neurological disease on the Parkinson’s-Alzheimer’s continuum is beginning earlier in life.
The concern may also reflect the perceived impact that conditions like Alzheimer’s have on families forced into becoming long-term care-givers. “As an increasing number of people are diagnosed with dementia, more people are seeing the profound impact that it can have on both the individual as well as the wider family,” said Paul Green.
Also, while there are orthodox medical treatments for heart disease and cancer, the public seems all too well aware that there are no effective drug treatments for the dementias, despite the billions spent on research. Hilary Evans of Alzheimer’s Research UK, said: “It’s no surprise to learn that fear of dementia in people over 50 is high: dementia affects over 820,000 people in the UK and we currently lack treatments to tackle the condition.”
What about heart disease?
If a client comes to you with scary (to them) cholesterol numbers, remember that studies show that LOW cholesterol is associated with greater risk of an early death, greater risk of death from respiratory and GI diseases, and greater susceptibility to infectious disease.(4,5)
With the number of articles we’ve run on this topic over the last 11 years, we hope we’ve established that cholesterol is vital for good health and that high cholesterol is rarely, if ever, the problem in heart disease. But still…it can be scary to advise clients according to this philosophy, especially if there is the stray thought that they will share the conversation with their GP, who is likely to be pushing them onto statins.
One thing we need is ALL the cholesterol de-bunking info and references in one place. Get this book: The Great Cholesterol Myth is the latest from Dr Stephen Sinatra and endorsed by IHCAN contributor Stephanie Senneff, among others. And its sub-title says it all. This book will give you more confidence to challenge the conventional approach, and you can comfortably recommend it to patients – and their doctors.
Sinatra and Dr Jonny Bowden DO test for cholesterol and triglycerides, as well as for inflammation, homocysteine, fibrinogen, blood sugar levels and so on. But, as Sinatra says, conventional “know your number” cholesterol testing – and associated treatment – is Stone Age.
“Granted, standard cholesterol testing is useful for determining whether your ratio of total HDL to LDL cholesterol is within a healthy range. But it won’t tell you about your HDL and LDL fractions (that is, whether you have predominantly small dense cholesterol particles, or large buoyant ones)”, says Sinatra. “Particle size is extraordinarily important, because new research shows that small dense LDL cholesterol is inflammatory and toxic to blood vessels. And even more troubling is a high level of lipoprotein(a), or Lp(a) – the most dangerous of the blood lipids. Lp(a) is a specific type of small LDL cholesterol particle, and it inflames the blood and makes it sticky – making it more prone to clotting.
“As with cholesterol, there are also different types of triglycerides. The type to be most concerned about is VLDL3, which is the most inflammatory triglyceride. It’s a prime indicator for the progression of heart disease, insulin resistance, and type 2 diabetes.”
Markers of inflammation, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) from standard blood testing, may be of equal importance as cholesterol data.
“One of my top missions has been is to educate people on the true cause of heart disease, and it’s not cholesterol”, says Sinatra. “Most doctors and cardiologists are still testing their patients’ cholesterol numbers and wearing out their prescription pads with orders for cholesterol-lowering statin drugs. Meanwhile the true cause of heart disease, inflammation, is still largely ignored.
Points from the book:
- The hypothetical link between high levels of total cholesterol and heart disease has NEVER been proven. It’s a diagnosis conjured up to serve drug companies who want to sell cholesterol-lowering statin drugs.
- Cholesterol levels are a poor predictor of heart attacks. Only about 50% of heart attack victims have high cholesterol levels, and 50% of people who have high cholesterol do not have heart disease.
- Lowering cholesterol has a very limited benefit in populations other than middle-aged men with a history of heart disease.
- Recent studies suggest statin drugs are associated with a higher risk of diabetes, which is a major risk factor for heart disease.
“Dr Bowden and I agree that while Big Pharma is busy raking in over $31 billion annually by selling high-cholesterol drugs with terrible side-effects to unknowing victims, their success is putting the public’s health at risk. Plus, all of this erroneous focus on high cholesterol is diverting research dollars away from the real cause of heart disease – inflammation.”
Chronic inflammation is a major predictor of coronary artery disease. Studies show elevated levels of CRP puts you at twice the risk of dying from cardiovascular-related problems as those with high cholesterol, say the authors.
Test for blood sugar damage
Neurologist Dr David Perlmutter, MD, author of Grain Brain, is popularising the term “type 3 diabetes” to describe Alzheimer’s and other dementias.
That’s because blood sugar levels are critical in inflammation. Now Perlmutter has gone one stage farther and is calling the haemoglobin A1c (HbA1c) test, “Your most important blood test”.
Diabetes.co.uk has also flagged up the importance of this test after the 2010 research out of the Johns Hopkins Bloomberg School of Public Health that showed that measurements of HbA1c more accurately identify people at risk of diabetes than the commonly-used measurement of fasting glucose.
The test checks for glycosylated haemoglobin – that is haemoglobin with glucose attached. It is a marker of long-term damage to proteins. And, as Dr Perlmutter explains, has significance way beyond blood sugar.
Perlmutter highlights “an incredibly important report” published in the British Journal of Cancer in March, showing a strong relationship between the simple blood test and the risk for various forms of cancer.(6) “The study found that the common blood test used by diabetics to measure their average blood sugar, A1c, was strongly predictive in terms of cancer development.”
Dr Perlmutter explains: “Basically, the A1c test measures the amount of glycation that the protein haemoglobin has undergone. Glycation simply means that sugar has become bonded to a protein, in this case haemoglobin, and this is a relatively slow process. Hence, it’s a way to get a sense as to how high the blood sugar has been, in this case over a three-four month period of time, and this is why it’s so helpful for diabetics.
“But with this new report, we now understand that having elevated A1c translates to risk for cancer, and as I’ve explained in Grain Brain, it is also a powerful indicator of risk for developing dementia.” A1c is also directly related to the rate at which the brain shrinks on an annual basis!
“Think of it, this one simple blood test can give you incredibly important information about cancer risk, risk for dementia, and even risk for shrinkage of your brain!” Perlmutter says.
Although an A1c of 5.6-5.8 is considered “normal”, Perlmutter recommends keeping it to 5.2 or even lower. “The way to accomplish this is simply by reducing your consumption of carbohydrates and sugar.”
He explains: “Why the process of glycation is such a bad player for health likely stems from the fact that when proteins are glycated (bound to sugar), it dramatically increases the production of damaging…free radicals. Free radicals end up damaging our protein, fat and even our DNA. In addition, glycation of proteins dramatically increases the chemical mediators of inflammation, and inflammation is the pivotal player in so many issues, including diabetes, heart disease, cancer, Parkinson’s, Alzheimer’s, multiple sclerosis, asthma and arthritis, just to name a few.
“Beyond keeping your carbs low, there are several ‘anti-glycating’ supplements that are helpful to reduce this process. These include alpha-lipoic acid, the omega-3 DHA, and a form of thiamine called benfotiamine.”(7)
Test for homocysteine
We all know homocysteine is a danger sign for heart disease. But thanks to the efforts of Patrick Holford and Dr James Braly, MD, (authors of The H Factor) among others, there is a growing awareness that getting homocysteine under control may be one of the most important things we can do for long-term health.
Braly and Holford have been accused of “overcooking” the significance of this amino acid. They say: “High levels of homocysteine…predict your risk of more than 100 diseases and medical conditions, including Alzheimer’s disease, cardiovascular disease, cancer and depression. In fact, it is even more accurate than a cholesterol reading for predicting the risk of heart attack or stroke. It also is the single best functional indicator of folate, B12 and B6 vitamin status. When homocysteine is high, one or more of these vitamins is low. Moreover, elevated homocysteine is an excellent biological marker for glutathione, SAMe, L-cysteine, and methyl donor deficiencies; when homocysteine is high, one or more of these critical anti-ageing, health-promoting natural body chemicals is deficient.”
But even conservative peer-reviewed studies tend to agree with them. This from a report from Symposium: Homocysteine, Aging and Geriatric Disease in the Journal of Nutrition: “Moderate hyperhomocysteinemia (tHcy up to 30mmol/L) (Kang et al. 1992), a common condition, is a major independent risk factor for a number of diseases characteristic of old age, primarily occlusive vascular disease (coronary, cerebral and peripheral) (Boushey et al. 1995) cognitive decline, including Alzheimer’s disease (Clarke et al. 1998), and possibly, senile osteoporosis (Miyao et al. 1998) and presbyopia (Krumdieck, unpublished). These disorders, which together account for much of the morbidity and mortality in the aged, are strikingly similar in all aspects but time of onset to the main manifestations of homocystinuria and could be considered as the clinical signs of a single disorder of late life, ie, chronic moderate hyperhomocysteinemia.
“The contribution of chronic moderate hyperhomocysteinemia to diseases of old age may have gone unrecognised because we are conditioned to accept them as inescapable consequences of growing old. The possibility of lessening the effect of hyperhomocysteinemia as a determinant of premature ageing by appropriate nutritional interventions known to lower tHcy, ie supplemental folate, vitamins B6 and B12, and reducing the intake of methionine, could change this perception.”(8)
Homocysteine is made in the body from methionine, and is converted to SAMe and glutathione – IF the necessary nutrient co-factors are available.
High homocysteine is thought to wreak its havoc through five main mechanisms:
- Accelerating free radical oxidation.
- Damaging cholesterol in arteries and leading to atherosclerosis.
- Increasing tendency of the blood to clot.
- Lowering levels of the key vasodilator nitric oxide.
- Promoting inflammation.
Test for vitamin D
Yes, there’s an ongoing debate about whether low vitamin D is a cause or an effect of disease, but studies that include thousands of comparatively “healthy” people have consistently revealed that huge percentages of any population studied are operating with less-than-adequate levels. Even the NHS admits that vitamin D deficiency is very common. “A recent survey in the UK showed that more than half of adults in the UK did not have enough vitamin D. In the winter and spring about one in six people have a severe deficiency. It is estimated that about nine in ten adults in the UK of South Asian origin may be vitamin D-deficient.”(9)
It’s interesting that “vitamin” D, actually a hormone, is produced from cholesterol, so it’s anybody’s guess how much orthodox medicine’s cholesterol/saturated fat phobia has contributed to declining D status.
We should be worried about D because low levels are associated with a slew of diseases. Only last month, a British-led international team of researchers discovered that people with a “moderate” deficiency were more likely to develop dementia. Again, D levels may be lowered BY the onset of Alzheimer’s and other neurological conditions.
Similarly, a UK study published earlier this year found that over-60s who were vitamin D deficient tended to have compromised immune function.(10)
The researchers at the University of Ulster in Coleraine commented: “This study is the first to find a connection between vitamin D levels and inflammation in a large sample of older individuals.”
It was only last year that vitamin D guidelines were issued to Britain’s GPs, courtesy of the National Osteoporosis Society, setting out recommended groups for vitamin D testing for the first time and also specifying levels.(11) Aimed solely at bone health, the guidelines suggest serum 25OHD < 30 nmol/L is deficient; serum 25OHD of 30–50 nmol/L may be inadequate in some people; serum 25OHD > 50 nmol/L is sufficient for almost the whole population.(12)
The dementia study (see box on page 26) also found a “threshold”, saying that above 50nmol/L is best for brain health.
Test and energise mitochondria
Prof Bruce Ames, emeritus professor of biochemistry and molecular biology at the University of California, and one of the world’s leading experts on free radicals, ageing and chronic disease, is one of many experts trying to focus our attention on the care and feeding of mitochondria as a key component of lasting good health.
“We have enough evidence to demonstrate that mitochondrial decay can contribute to degenerative diseases, including cancer and neurological decline, that are all associated with ageing”, says Ames. “The impact of mitochondrial decay is far-reaching. Old mitochondria generate increased amounts of mutagenic by-products along with decreased membrane potential and cellular oxygen consumption. All of this decline cascades into DNA and RNA damage and into cells, tissues, and eventually the organs. Our inability to produce ATP as we did when we were younger is also a result of ageing mitochondria.”(13)
The “standard” formula for boosting numbers and quality of mitochondria (apart from serious aerobic and/or intense anaerobic training) is to use supplements of CoQ10, PQQ (Pyrroloquinoline quinone) and the Ayurvedic herb Shilajit. However one of Ames’ most startling recent contributions was his co-discovery that supplemental acetyl-L-carnitine and antioxidant lipoic acid were able to “reboot” ageing rat and dog mitochondria to youthful functions and, tellingly, partially restore memory, thanks to regeneration of mitochondria in the brain.(14)
And if you want more evidence that carnitine might help your older patients, have a glance at the 2007 study on centenarians: placebo-controlled and double-blinded, with the control group receiving a placebo, while the treatment group got 2g of carnitine a day.(15) This group was 66 Italians, all “at least” 100 years old, showing signs of fatigue after even slight physical activity.
The researchers concluded that “oral administration of levocarnitine produces a reduction of total fat mass, increases total muscular mass, and facilitates an increased capacity for physical and cognitive activity by reducing fatigue and improving cognitive functions”. Or to break it down, the carnitine group:
- Increased muscle mass by 8.4lb and LOST 4lb of body fat.
- Showed significant improvement in physical fatigue.
- Dramatically improve mental fatigue while the placebo group actually worsened.
- Improved 4.1 points on the 30-point mini mental status examination (MMSE) score (no change in the placebo group).
The researchers explain: “l-carnitine is indispensable for the transport of long-chain fatty acids across the inner mitochondrial membrane to their site of oxidation and the production of energy in the form of ATP. Among all the substances whose concentration decreases with age, l-carnitine diminution is fundamentally important, given its function in the production of energy. One of the most important consequences of carnitine deficiency is therefore manifested in the alteration of the metabolic pathways that lead to the production of energy.”
Leading the charge in the investigation of mitochondria in the UK is chronic fatigue expert Dr Sarah Myhill. She is the co-author of two published papers setting out the hypothesis that CFS/ME is a mitochondrial dysfunction disorder, with Prof Norman Booth of the University of Oxford, and Dr John McLaren-Howard of Acumen Laboratory.(16) Along the way, McLaren-Howard has developed state-of-the-art testing for mitochondria, the Mitochondrial Function Profile.
In July, Dr Myhill published her book on CFS. Read the first 40 pages here: www.book2look.de/vbook.aspx?id=kwtry1zukp
- Office for National Statistics (2013); “2012-based Population Projections for GB,” – https://www.ons.gov.uk
- The Digital Health Market 2012–2020: www.sharpbrains.com
- Direct communication.
- Jacobs D et al. Report of the conference on low blood cholesterol: Mortality associations. Circulation 1992, 86(3): 1046-60.
- Iribarren C et al. Serum total cholesterol and risk of hospitalization, and death from respiratory disease. Int J Epidemiol 1997, 26(6): 1191-202.
- De Beer JC, Liebenberg L. Does cancer risk increase with HbA1c, independent of diabetes? Br J Cancer 2014, 110(9): 2361-8.
- Dr David Perlmutter info sourced from his presentation at the Integrated Health Symposium, New York, 2014, and from www.drperlmutter.com
- Krumdieck CL, Prince CW. Mechanisms of homocysteine toxicity on connective tissues: Implications for the morbidity of aging. J Nutr 2000, 130(2S Suppl): 365S-68S.
- “Vitamin D Deficiency including Osteomalacia and Rickets”: www.patient.co.uk.
- Laird E et al. Vitamin D deficiency is associated with inflammation in older Irish adults. J Clin Endocrinol Metab 2014, 99(5): 1807-15.
- Price C. Vitamin D testing guidance to prompt ‘sea change’ for GPs. Pulse April 23, 2013.
- Vitamin D and bone health: a practical clinical guideline for patient management. National Osteoporosis Society: www.nos.org.uk/document.doc?id=1352
- Smith P. Life Extension® interview with Dr Bruce Ames. Life Extension Magazine, August 2011: www.lef.org.
- Liu J et al. Memory loss in old rats is associated with brain mitochondrial decay and RNA/DNA oxidation: Partial reversal by feeding acetyl-l-carnitine and/or r-alpha -lipoic acid. Proc Natl Acad Sci USA 2002, 99(4): 2356-61.
- Malaguarnera M et al. L-carnitine treatment reduces severity of physical and mental fatigue and increases cognitive functions in centenarians: A randomized and controlled clinical trial. Am J Clin Nutr 2007, 86(6): 1738-44.
- https://drmyhill.co.uk/wiki/CFS_-_The_Central_Cause:_Mitochondrial_Failure. This page has links to papers.