Our weight matters.

How many of us today struggle with weight issues? We appear obsessed with seeking a way, any way, to help us to lose those excess kilos. Just look in any book-store and there are dozens of books instructing us how to lose weight. We have nightly current affairs programs discussing the latest “secrets” or diet craze.
We even have television programs documenting weight loss as a competition, with “The Biggest Loser”

Why is obesity a concern for our brain?

Being overweight or obese carries a number of significant health issues. Not least of which include Type two diabetes and heart disease.
Our calorie dense diets and sedentary lifestyle compound the problem.

One of the other issues less well known about from being overweight is the effect it has on our brain. Our memory and thinking skills are impaired when we are overweight.

Obesity is associated with a shrinking brain. The total brain volume is reduced and the amount of grey matter (our neurons in our cortex) is less dense.

Worse still, being overweight in middle age (BMI 25-40) is associated with a 70% increase risk of dementia. If you are obese, make that x 4 the risk. There is also a gender bias, with women being particularly at risk.

Apart from the increased risk of diabetes and vascular disease, both of which are risk factors for dementia, being obese means the body and brain are subjected to higher levels of inflammation. The fatty tissue itself secretes inflammatory cytokines and other chemicals.

So, is weight loss the answer?

In a nutshell, yes.

This has recently been confirmed by a study on people who have undergone bariatric surgical procedures to achieve weight loss.
Bariatric medicine deals with the cause, prevention and treatment of obesity.
Increasing numbers of people have been resorting to surgery in a desperate attempt to lose weight when all other avenues appear to have failed.

The surgery often produces significant weight loss over a relatively short period of time. This made this type of procedure ideal as a means to study what impact if any, the surgery produced on memory and cognitive function of the obese.

A total of 150 people participated in the trial. 109 underwent a bariatric procedure.
Prior to the surgery many of the group exhibited impaired performance on cognitive testing.

In just twelve weeks postoperatively, these results had improved from slight impairment to returning to a normal range.

The study will continue with repeated testing at one year and two years postoperatively.

This is obviously really good news to show that such cognitive impairment can be reversed with successful bariatric procedures. Further studies will look to see whether the same sort of result can be achieved using conventional weight loss techniques of diet and exercise. It could also be, that as successful weight loss is achieved, we are more likely to remain motivated to keep eating more healthily and to keep exercising, both of which are really important factors to help us retain our cognition.

The prospect of being able to improve your memory and thinking skills by keeping your weight in the healthy weight range is a very powerful motivator. Plus it reduces that risk of dementia in later years.

Many of us worry about our health and our brain as we age, the impact of our genes and what we can do to help ourselves.
But it looks as if ensuring we keep to a healthy weight range across our lifespan is a really great way to start.

refs:

John Gunstad et al. Improved memory function 12 weeks after bariatric surgery. Journal of the American Society for Metabolic and Bariatric Surgery, 2010 DOI: 10.1016/j.soard.2010.09.015

http://opinionator.blogs.nytimes.com/2010/04/20/brain-damage/

It probably wouldn’t come as any great surprise that people who have to work in close contact with pesticides might suffer some unpleasant ill health side effects. After all, pesticides are strong chemicals designed to kill pests, which would otherwise damage the crop being grown.

A recent study published in Occupational and Environmental Medicine has suggested that long-term exposure to pesticides may be linked to the development of dementia.

The researchers were looking to see what the impact of long term pesticide exposure was on cognitive abilities on people in their 40’s and 50’s. These were people who had all spent at least 20 years working in the agricultural sector.

614 vineyard workers in South West France had their intellectual capacity monitored as part of the PHYTONER study spanning a six year period.

The level of pesticide exposure was divided into 3 groups

• Direct exposure through mixing or applying pesticides, or contact with cleaning or spraying equipment.
• Indirect exposure from contact with treated plants and possible indirect exposure from working in cellars and associated office buildings.
• No exposure ie they had not worked in any of the above areas.

The 614 subjects were monitored between 2001 and 2003. They were each asked to complete a questionnaire and complete nine neuro-behavioural tests designed to measure memory and recall, language retrieval and verbal skills and reaction time speeds.
Half of the group were in the direct exposure category, 20% had had no exposure and 30% had had indirect exposure.

Lower scores were found in the older workers, those with a lower level of education, excessive alcohol intake, depression or drug use which was no unexpected.

However it was also shown that in seven out of nine tests, those who had been exposed to pesticides performed significantly worse on the second testing at the end of just two years.

This group were up to x5 more likely to have scored lower in both tests and x2 as likely to register a drop of two points in the mini mental state exam (MMSE) This is a test frequently used by General Practitioners to determine if a person has dementia. It is a brief 30 point test. A score of 25 or more out of thirty is considered normal. A score of 20 to 24 indicates mild cognitive impairment.

A two point loss in this group over such a short time frame is of concern and especially as this was in a group of 40 and 50 year olds.
Previous studies have indicated that exposure to pesticides is associated with poor mental performance.

This demonstration of mild impairment of cognition or thinking skills is a worry as it suggests that this group of people are at higher risk of developing neurodegenerative disease such as Alzheimer’s and other dementias.

For baby boomers and others, considering moving to that idyllic lifestyle of perhaps owning and running your own vineyard, there may be a higher cost to pay. Certainly food (or should that be pesticide?) for thought.

Baldi, A. Gruber, V. Rondeau, P. Lebailly, P. Brochard, C. Fabrigoule. Neurobehavioral effects of long-term exposure to pesticides: results from the 4-year follow-up of the PHYTONER Study. Occupational and Environmental Medicine, 2010; DOI: 10.1136/oem.2009.047811

Statisticians have been telling us how Western societies are facing a tsunami of people developing dementia and Alzheimer’s over the next couple of decades. This is associated with our ageing population; we are all living longer, so our relative risk of developing dementia rises as well.

What worries me though is the fact that we seem to be ignoring the impact that the dramatic increase in people living with Type 2 diabetes and obesity will have on these figures.

Both diabetes and obesity are known risk factors for dementia.
Adults who develop diabetes before the age of 65 have twice the risk of developing dementia compared to non-diabetics and also have an increased risk of depression.

It is our children that worry me the most. Twenty years ago the number of kids diagnosed with Type 2 diabetes was in the order of 2%. It was an extremely rare condition. Now 30 to 50% of all those diagnosed with Type 2 diabetes are between the ages of 9 and 19 years. Those aged in their thirties, have seen a 70% increase in the number of people diagnosed.
The scary thing also, is that it is known that there are an even greater number of people with undiagnosed diabetes in the general population.

What is Type 2 diabetes?

When we eat a meal, the carbohydrates in it are broken down and released into our blood stream as sugar, leading to an increase in the blood sugar level. This then stimulates the pancreas gland to release insulin hormone which works to restore the blood sugar level back to normal by sending the glucose to tissues that need it for energy, or for storage. If the body is repeatedly overloaded with excess glucose, the body’s ability to respond to the insulin is diminished, leading to a condition called insulin resistance. Increasing amounts of insulin then get produced, but it can no longer exert its effect. This is the condition of Type 2 diabetes where blood sugar levels are consistently too high and associated with elevated insulin levels.

It is distinguished from Type 1 diabetes where the specialised glands in the pancreas are unable to produce insulin.

When are we going to wake up to this risk?

If you have diabetes, you have a higher risk of cognitive decline and dementia.

In a study of 2300 older women aged 70 to 78, non-diabetics on mental testing scored twice as high as diabetics. It was also found that the longer the person had had diabetes, the more poorly she performed.

In another multiethnic, multicenter study of 10,000 people, the results of cognitive tests taken 6 years apart were compared. In the 40 to 70 year age group, diabetes was again linked to greater cognitive decline.

What does diabetes do to the body and brain?

Diabetes affects multiple organs in the body including the blood vessels, heart eyes, brain and kidneys and is insidious in how it gradually erodes cognitive ability. Elevated blood sugar levels contribute to hardening of the arteries, (atherosclerosis) which increases the risk of heart disease and stoke. In the brain, this vascular damage is linked to an increase in small infarcts (injury to small arterioles in the brain) or tiny strokes. Having persistently elevated blood sugar contributes to damage of our brain cells, brain atrophy and cognitive impairment. The loss of brain cells is especially prominent in the area of the hippocampus, the specialised brain area concerned with memory and learning.
Diabetic patients who have developed diabetic retinopathy have been shown to have twice the risk of developing cognitive impairment.

Excess insulin also contributes to the brain damage. It has been discovered that the brain has it’s own insulin receptors. Increased insulin levels have been linked to increased levels of amyloid, the protein associated with plaques found in Alzheimer’s. Excess insulin also has a role in stimulating inflammation, and reducing the levels of acetylcholine an essential neurotransmitter for memory.

But it’s not just diabetics who are at risk of impaired brain function and reduced mental performance. It has been shown that drinking a sugary glucose drink will adversely affect your ability to perform memory tests. So the key is to avoid big swings in blood sugar levels.

Because we know that diabetes is associated with an increase risk of cognitive impairment and dementia, it is vital that the message gets out to all those at risk.

The good news though, is that we know that good lifestyle choices can have a hugely beneficial effect on blood sugar control.

The aim is to

• Keep blood sugar levels in the normal range
• Maintain a healthy body weight
• Eat a nutritious and brain healthy diet low in saturated fat
• Exercise for 30 minutes a day by walking or other moderate intensity activity.

My question to you is this. Can we afford not be taking immediate steps to educating people to fully understand the consequences of “accepting” the recent global increases in obesity and diabetes?

Our sweet tooth is killing our brain.

Refs:
Roberts et al. Association of Duration and Severity of Diabetes Mellitus With Mild Cognitive Impairment. Archives of Neurology, 2008; 65 (8): 1066 DOI: 10.1001/archneur.65.8.1066
University of Southern California (2009, January 28). Getting Diabetes Before 65 More Than Doubles Risk For Alzheimer’s Disease.

How many times does it happen that we lose our keys?
First of all you realise they are not in the place they normally are, and then (as it usually seems to occur when you in a hurry to get to an appointment or something) you rummage quickly through the other “likely” places where they often get put down.

Not there either?
OK, now it’s time to go backwards using your memory. When do you know you definitely last had them and what did you do after that ?
This process will then hopefully lead to where the missing keys were inadvertently put.

Not an uncommon scenario in many households.
But is forgetting where we put down our keys or forgetting people’s names or trying to think why we have walked into the garage to look for something, a sign of something more sinister happening?

Could you be showing early cognitive impairment which could lead to Alzheimer’s disease?

We are in a rapidly ageing population where sadly the reality is, that for those of us now enjoying a longer lifespan, 10% of us will have dementia by the age of 65 years of age and 40-45% of us by the time we are 85 years old.
Seeing as we are now expected to live to between 79 and 85 years on average, that is a pretty scary scenario. So, if we live to our full lifespan, we have nearly a 50% chance of having dementia.

Some Health Organisations are now predicting that by 2040, neurodegenerative diseases will account for more deaths than cancer.

The good news is that losing your keys does not necessarily imply a neurodegenerative problem on it’s own.
We are also now learning more and more about the brain’s amazing capacity to maintain itself and allow us to continue to learn and retain new memories throughout our lives.
Cognitive Reserve is a term that relates to our brain’s ability to preserve itself against neuronal loss and loss of function.
Some of the things we now know in regard to this include brain size, number of neurons, the level of education achieved and the amount of continued learning, our lifestyle and the effect of stress.

In a nutshell: the larger our brain the greater we are protected from dementia. The number of neurons we have working will also influence how we continue to function. Studies have shown that people who have obtained a higher level of education and those who are life long learners are afforded a certain level of protection.
How we live in terms of lifestyle, diet, exercise, smoking and drinking plays an important role in maintaining cognitive reserve as does avoiding stress.

Stress kills brain cells!
So, the next time you can’t find your keys, don’t stress. Because you want to keep those neurons working to help you find them the next time it happens.