One of the guiding principles of naturopathic medicine is prevention. For COVID, that means wearing masks and social distancing are among the most effective naturopathic therapies — to prevent infection from occurring in the first place. Another form of prevention is now available to us: the COVID vaccines.

Vaccination is a controversial topic in natural healthcare. As a naturopathic physician with a background in biological science, I always take the approach of weighing risks and benefits. The risks of the COVID pandemic are clear – we see them on the news as well as the scientific journals on a daily basis. The Pfizer-BioNTech and Moderna vaccines that received emergency use authorization by the FDA in December have very good safety profiles. While there it is certainly possible that more adverse reactions may appear as more people get vaccinated, the results so far continue to show only minor side effects.

Given this risk/benefit analysis, when I got the opportunity as a health care provider to be among the first to receive the COVID vaccine, I chose to roll up my sleeve and receive it.

The only side effects I experienced were mild headache for half a day and soreness at the injection site for about 3 days. The benefits I see are being able to render natural healthcare to my patients more safely and confidently.

If you are hesitant about this vaccine because of rumors you have heard about its safety, please consider the source. Is it credible? Does it have access to the facts and the science? What is the basis for your trust in information sources? As for me, show me the data — I trust the science.

I understand that vaccination is an individual choice — but it is one that affects us all, especially the most vulnerable members of our community. When you get the opportunity to receive the COVID vaccine, please consider it — not just for your own health, but for the protection of your loved ones. This is not about “choosing not to live in fear” — it’s more like the choice that you make to buckle your children into car safety seats. Or not to smoke in the same room as an elderly or sickly relative.

This is about the impact our choices have on all of those around us. We’re all in this together, my friends.

These are important findings, not only because Alzheimer’s disease is projected to become ever more common as the population ages, but because current treatment options offer minimal improvement at best. Last July, a large clinical trial found little benefit in patients receiving a major new drug called LMTX. And after that, another hopeful drug designed to target amyloid protein, one of the hallmarks of Alzheimer’s disease, failed its first large clinical trial as well.  Just two months ago, Merck announced the results of its trial of a drug called verubecestat, which is designed to inhibit formation of amyloid protein. It was found to be no better than placebo.

The results from UCLA aren’t due to an incredible new drug or medical breakthrough, though. Rather, the researchers used a protocol consisting of a variety of different lifestyle modifications to optimize metabolic parameters – such as inflammation and insulin resistance – that are associated with Alzheimer’s disease. Participants were counselled to change their diet (a lot of veggies), exercise, develop techniques for stress management, and improve their sleep, among other interventions. The most common “side effect” was weight loss.

The study is notable not only for its remarkable outcomes, but also for the alternative paradigm it represents in the treatment of a complex, chronic disease. We’ve spent billions of dollars in an effort to understand the molecular basis of Alzheimer’s in the hope that it will lead to a cure, or at least to more effective therapies. And although we have greatly enlarged our knowledge of the disease, it has not yielded many successful treatments.

The situation is analogous in kind, if not quite degree, to the many other chronic diseases with which we now struggle, such as diabetes and cardiovascular disease. While we do have efficacious medications for these conditions, none work perfectly, and all have negative effects. Our understanding of the cellular processes at the root of these diseases is sophisticated, but technical mastery – the grail of a cure – has remained elusive.

Acknowledging these difficulties, the researchers at UCLA opted for a different approach. Beginning from the premise that Alzheimer’s disease is a particular manifestation of a highly complex system in disarray, they sought to optimise the system by changing the inputs. Put another way, the scientists chose to set aside the molecular box which has proven so vexing, and to focus instead on the context of the box itself. Although we cannot say precisely how the intervention worked, on a cellular level, the important thing is that it did work.

The method isn’t entirely novel. Researchers have already shown that multi-faceted, comprehensive lifestyle interventions can significantly improve outcomes in cardiovascular disease, diabetes and hypertension. But it’s difficult for these approaches to gain traction for two reasons. First, these protocols are more challenging than simply taking a pill at bedtime. Patients need ongoing education, counselling and support to effect meaningful change. And second, the pharmaceutical mode of treatment is deeply embedded within our current medical system. Insurance companies are set up to pay for medication, not lifestyle change; and physicians are taught pharmacology, not nutrition.

Despite these difficulties, it’s time to start taking these approaches much more seriously. The prevalence of Alzheimer’s disease is expected to triple over the next three decades, to nearly 14 million in the United States alone. Diabetes and other chronic diseases are expected to follow a similar trajectory. Trying to confront this epidemic with medication alone will raise a new host of problems, from prohibitive cost to adverse effects, without addressing any underlying cause. We know that comprehensive lifestyle modification can work for many chronic diseases, in some cases as well as medication. It deserves more than passing mention at the end of an annual check-up – it’s time to make it a cornerstone in the treatment not only of Alzheimer’s disease, but of all chronic disease.

by Clayton Dalton, medical resident at the Massachusetts General Hospital in Boston

This article was originally published at Aeon and has been republished under Creative Commons.

In 2015, the Institute of Medicine provided this definition of the condition:

1. a substantial reduction or impairment in the ability to engage in pre-illness levels of occupational, educational, social, or personal activities that persists for more than 6 months and is accompanied by fatigue, which is often profound, is of new or definite onset (not lifelong), is not the result of ongoing excessive exertion, and is not substantially alleviated by rest;
2. postexertional malaise (often described by patients as a “crash” or “collapse” after even minor physical or mental exertion);
3. unrefreshing sleep; and
4. cognitive impairment and/or orthostatic intolerance.

There have been recent developments in this field that take some steps forward. In late 2016, the International Association for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (IACFSME) research conference emphasized the role of postexertional malaise (an energy “crash”) following physical exertion or emotional distress, rather than just general fatigue, as the most important aspect of ME/CFS. This has been verified through experiments that test physiologic function in ME/CFS patients following exercise.

Conference speakers also reported on some possible laboratory tests that could identify the abnormalities associated with ME/CFS. Kenny L. DeMeirleir, MD, PhD found that the four blood tests that were most helpful were prostaglandin E2, interleukin 8, soluble CD14, and CD57+ lymphocytes — all of which are associated with an inflammatory immune response. This combination of tests is already being used as a panel to diagnose ME/CFS in Belgium, where Dr. DeMeirleir is originally from. Jose Montoya, MD, professor of medicine at Stanford University, found abnormalities in levels of 17 specific cytokines (chemical messengers used by immune cells) that correlate with the condition. U.S. researchers caution that larger studies are needed before either panel is adopted in this country for diagnosis of ME/CFS.

Researchers at the University of California San Diego School of Medicine published an extensive study in 2016 about what is actually going on inside the body’s cells in ME/CFS. Without getting too deep into the technical information, they found several problems with the cell’s ability to produce energy from the nutrients that we get from food. Other scientists presented information at the IACFSME conference that suggested that a slightly altered gene (called a single nucleotide polymorphism, or SNP [pronounced “snip”]) may be responsible for the body’s inability to process energy correctly.

What is emerging, then, is a picture of a genetic predisposition toward less efficient energy production, that may be aggravated by some outside factor, such as infection or environmental toxins. Those outside influences then set up a chronic inflammatory state that affects the brain in particular. Physical exertion or emotional distress can aggravate the inflammatory messengers in the body, leading to “crashes” (postexertional malaise). I speculate that this could be the explanation of why some people are “wiped out” for years by something that should be temporary, such as a Lyme disease infection, or an adverse reaction to medication like Cipro. This is also why trying to fight the inciting factor is so often ineffective (like years of antibiotics for Lyme, or elaborate detox protocols for medication reactions). Careful evaluation of a patient’s metabolic state, and appropriate lifestyle and nutritional support (in particular, for mitochondrial energy production) is probably the more effective strategy.

References:

1. IOM Gives Chronic Fatigue Syndrome a New Name and Definition. Medscape. Feb 10, 2015.
2. Postexertion ‘Crash,’ not Fatigue per se, Marks Syndrome. Medscape. Nov 04, 2016.
3. Biomarker Research Advances in ‘Chronic Fatigue Syndrome’. Medscape. Nov 08, 2016.

In recent years, a group of Canadian researchers at McMaster University has bucked this trend by studying a combination of herbs and nutrients for brain health. This combination includes common ingredients such as B vitamins, ginkgo biloba, flaxseed oil, and green tea. The latest research on this combo in a mouse study found that when it was fed to mice with massive brain cell (neuron) loss (equivalent to advance Alzheimer’s disease in humans), it prevented, and even reversed the death of neurons.

Read that again — it reversed the brain cell loss associated with neurodegenerative diseases like Alzheimer’s, Parkinson’s, and others.

No pharmaceutical drug has ever been shown to have this effect. A major part of the problem with treating neurodegenerative diseases is something called the blood-brain barrier (BBB): a cellular “wall” that acts like the velvet rope at the nightclub of our brain, preventing most large molecules from crossing from the bloodstream into the brain. Combinations of smaller molecules and specific fats found in the natural supplement may be able to cross the BBB. They’re on the celebrity A-list for the club.

There is one major caveat to keep in mind with this study: effects found in mice don’t always translate to the same benefits in humans. However, given the potential upside with very low risk, this is a worthwhile strategy to try if there is existing brain disease, or high risk of conditions such as Alzheimer’s or Parkinson’s.

Here is the complete list of ingredients in the McMaster group’s supplement:

Component	Target	Component	Target
Vitamin B1	Insulin sensitivity, anti-inflammatory	Flax seed oil	Omega fatty acids for membrane support
Vitamin B3	Insulin sensitivity, anti-inflammatory	Folic acid	Antioxidant, maintains glutathione levels, endothelial support
Vitamin B6	Insulin sensitivity, anti-inflammatory, scavenges	Garlic	Antioxidant in lipid membrane, scavenges , H2O2
Vitamin B12	Insulin sensitivity, anti-inflammatory	Ginger	Antioxidant in cytosol, scavenges OH−, , ONOO−
Vitamin C	Antioxidant in cytosol, scavenges , H2O2	Ginkgo biloba	Antioxidant in cytosol, scavenges NO−
Vitamin D	Antioxidant in lipid membrane	Ginseng	Antioxidant in cytosol and nucleus, scavenges OH−, , ONOO−
Vitamin E	Antioxidant in lipid membrane, scavenges , H2O2	Green tea extract	Antioxidant in cytosol, scavenges H2O2, OH−
Acetyl L-carnitine	Mitochondrial support, antioxidant in mitochondria, insulin sensitivity	L-glutathione	Enzymatic antioxidant support, antioxidant in cytosol
Alpha lipoic acid	Mitochondrial support, antioxidant in mitochondria, insulin sensitivity	Magnesium	Insulin sensitivity, cellular support
ASA	Anti-inflammatory, scavenges NO−	Melatonin	Antioxidant in cytosol and nucleus, scavenges OH−, H2O2, O−, NO, ONOO−
Beta carotene	Antioxidant in lipid membrane, scavenges , H2O2	N-acetyl cysteine	Mitochondrial support, antioxidant in mitochondria
Bioflavonoids	Antioxidant in cytosol and nucleus, scavenge OH−, , metal chelator	Potassium	Insulin sensitivity, cellular support
Chromium	Insulin sensitivity, scavenges H2O2	Rutin	Antioxidant in lipid membrane, scavenge OH−, , metal chelator
Cod liver oil	Omega fatty acids for membrane support	Selenium	Scavenges H2O2, enzymatic antioxidant support, insulin sensitivity
CoEnzyme Q10	Mitochondrial support, antioxidant in mitochondria	Zinc (chelated)	Neural support (zinc + antioxidants), insulin sensitivity
Dehydroepiandrosterone	Antioxidant, endocrine support

By way of background, in the mid-twentieth century, there were two main competing hypotheses as to the dietary culprit behind cardiovascular disease: too much refined carbohydrates (sugar) or too much saturated fat. Medical research published in the 1960s put the balance of evidence in the saturated fat column, thus kicking off decades of low-fat dietary advice. This has become such dogma in science and in our culture, that most people failed to notice the 2010 paper that concluded that there was no correlation between saturated fat intake and the development of cardiovascular disease. As science progresses, it is not unusual for theories to be revised in the face of new evidence — and nutritional research is notoriously tricky under the best of circumstances. However, how were scientists so wrong for so many years?

In September 2016, JAMA Internal Medicine published some shocking papers that proved that this was not an accident. In 1967, a sugar industry trade group called the Sugar Research Foundation paid Harvard University researchers the equivalent of almost $50,000 in today’s dollars to publish a review article on the role of diet in heart disease. The SRF cherry-picked the articles to be included in the review–and not surprisingly, they only chose studies that exonerated sugar and blamed saturated fat. Documents showed that SRF executive John Hickson was actually involved in reviewing all drafts of the paper, and he wrote, “Let me assure you this is quite what we had in mind, and we look forward to its appearance in print.”

There’s no two ways about this. This was outright paid advertising.

The study was published in the New England Journal of Medicine, a paragon of scientific integrity, so almost no one questioned the conclusions. One of the scientists paid by the SRF was Dr. D. Mark Hegsted, who later went on to head the US Department of Agriculture, and draft some of the first federal dietary guidelines in 1977. Not surprisingly, a cornerstone of those guidelines was to minimize saturated fat intake. And thus led to a shift in American eating patterns to the low-fat diet crazes of the 1980s and 90s–but instead of replacing those fat calories with fruits and veggies, we started filling up on sugar and other refined carbohydrates (SnackWells, anyone?). And right along with that is when obesity rates began to skyrocket in this country.

If you think you shouldn’t worry about this, because it was so long ago and we’re more enlightened now, keep in mind that the Coca-Cola Company gave millions of dollars in recent years to researchers who sought to downplay the link between sugary beverages and obesity.

For your own health, stick with a low-glycemic index, Mediterranean diet — low in refined carbohydrates, but not skimping on healthy fats from nuts and olive oil — which has been shown to reduce risk of cardiovascular deaths by 30% compared to the low-fat approach. Keep up with nutrition research–and always question where the funding is coming from.

Reference: Kearns CE et al. Sugar Industry and Coronary Heart Disease Research: A Historical Analysis of Internal Industry Documents. JAMA Intern Med. Published online September 12, 2016. doi:10.1001/jamainternmed.2016.5394

A study led by Dr. Liana Del Gobbo at the Stanford University School of Medicine examined the question of omega-3 fats and heart attack. This study analyzed data from over 45,000 people from 16 countries over a 10-year period. It differed from many previous studies in that instead of relying on diet recall, it looked at actual blood levels of omega-3 fats. For every standard deviation increase in omega-3 levels, there was a 9% decreased risk of fatal heart attack. This included both fish-derived omega-3s, as well as plant-derived omega-3s (from walnuts, flaxseed, etc.). Important points to note are that these people did not have heart disease at the beginning of the trial period, and they were not taking omega-3 supplements – their source was diet.

Another recent study confirmed the connection between omega-3s and protection against Alzheimer’s disease. Researchers at the University of Southern California examined older adults, and found that low blood levels of DHA (one of the primary omega-3 fats in fish oil) were associated with higher levels of amyloid plaque – the gunk in brain cells that seems to cause Alzheimer’s disease. They caution, of course, that this does not mean that fish oil supplements can prevent or cure Alzheimer’s disease: this study just showed correlation, not causation.

In both studies, the researchers emphasize dietary sources of omega-3 fats rather than supplementation. While I agree with this approach in general, I feel that fish oil supplementation can fill in the gap when we are not getting the recommended 2-3 servings of cold water fish per week. These studies differed from previous studies that used fish oil supplements like drugs – comparing them to placebo over a relatively brief period of time, often in patients who were already sick. This latest research shows that when it comes to omega-3s, prevention is the best bet. Start eating fish or taking fish oil regularly in your 20s and 30s, rather than waiting to rely on it in your 60s or 70s after the first heart attack.

References:

• Del Gobbo LC, Imamura F, Aslibekyan S, et al. ω-3 polyunsaturated fatty acid biomarkers and coronary heart disease: Pooling project of 19 cohort studies. JAMA Intern Med 2016; DOI:10.1001/JAMAINTERNMED.2016.2925.Abstract
• AMA Neurol. Published online August 8, 2016. Abstract  Editorial

Pokémon Go actually uses the photos and data submitted by users of Ingress. Unlike its predecessor, though, this current game rocketed to stratospheric popularity – garnering more users in the first week of its US release than the legendary Candy Crush Saga.

As long as people are aware of their surroundings – not doing anything dangerous or illegal – I’m all in favor of something that encourages more physical activity and social interaction.

Pokémon Go Wiki (a guide for getting started and strategies)

Gamification

The U.S. government will soon be updating Nutrition Facts requirements again. Among the changes:

• It will list how much added sugar is in a processed food. This is important, since added sugars are one of the leading detriments to Americans’ health. The recommended maximum is 50 grams daily; the average American eats over twice that amount (115 grams, or about 23 teaspoons).
• Serving sizes will be updated to more closely reflect the amount of a food people actually eat. Artificially small serving sizes distort the amount of calories, fat, and sodium listed.
• Calories will be larger and bolder.
• Daily values will be updated to reflect the most recent science. The daily value for fiber (one of my favorite nutrients) has been increased from 25 grams to 28 grams, for example.
• Potassium and vitamin D, two nutrients that Americans tend not to get enough of, will now be featured on food labels.

Some food industry leaders have fought these changes – food labeling has always been as much (or more) about marketing and politics than about science. So it’s good to see nutritional science taking the upper hand for once. This continues the positive trend we saw the last couple of years with the introduction of NuVal, a single number to express the overall nutritional quality of a food. Not surprisingly, that science-based, user-friendly system was the result of actual nutritional science experts, not a government committee.

Of course, the truly healthiest choices are whole foods – fresh lean meats and fish, fruits, vegetables, and whole grains. But when we do select packaged foods, we will soon have better information at our disposal.

Reference: Changes to the Nutrition Facts Label (http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/LabelingNutrition/ucm385663.htm)

Researchers followed a group of of nearly 30,000 Swedish women over a 20-year period. Those with the highest level of sun exposure had a decreased risk of death from cardiovascular disease and other non-cancer chronic diseases. On average, sun exposure led to an increase of up to 2.1 years of life expectancy. On the opposite side of the coin, avoiding sun exposure was similar to smoking in its magnitude of risk for death from those chronic diseases.

Increased sun exposure did indeed lead to more skin cancer; however, those cancers tended to have a better prognosis. So on balance, the decreased risk of other diseases outweighed the increased cancer risk.

One big question remains unanswered: are these benefits due to vitamin D? We know that the body’s own vitamin D production increases with more sun exposure, and that low vitamin D levels are associated with risk of chronic diseases. However, the jury is still out as to whether or not vitamin D supplementation by itself improves cardiovascular outcomes. For now, it looks like the UV exposure from the sun is the best way to go.

So, should we all sunbathe for hours per day? One major caveat from this study is that Sweden, due to its northern latitutde, gets much less UV exposure than the U.S. Also, this study looked only at women. The best approach would seem to be moderation: 15-30 minutes of sun exposure about three times per week is a good goal to shoot for.

Reference:

Lindqvist PG et al. Avoidance of sun exposure as a risk factor for major causes of death: a competing risk analysis of the Melanoma in Southern Sweden cohort. J Intern Med. Published online March 16, 2016.

Some of the most exciting highlights of the research from this past year:

• Researchers found that a Western diet (lots of junk food) actually shrinks the hippocampus, a brain structure involved in mood regulation (1)
• Data from the Women’s Health Initiative study found that a high-glycemic index diet (that is, lots of sugars and white flour products) increases the risk of depression (2)
• Cocoa and chocolate are rich in flavonoids that improve cardiovascular health – and now have been found also to improve cognitive function (thinking) (3)
• A whole foods-based diet, especially one following the Mediterranean pattern, is associated with improvement in depression and anxiety (4)
• A placebo-controlled study found that a specific probiotic supplement (Lactobacillus acidophilus, Lactobacillus casei, and Bifidobacterium bifidum) significantly improved symptoms of depression, along with metabolic health markers like C-reactive protein (hsCRP). (5) This builds on previous evidence showing decreased moodiness with probiotic intake.

In addition to a whole foods-based diet and probiotics, don’t forget that exercise is one of the most powerful natural antidepressants there is. If additional mood support is needed, there are many powerful herbs and nutrients that can help – just be sure to use them with appropriate guidance, since some (like St. John’s wort) can have significant interactions with drugs.

1. Jacka FN, Cherbuin N, Anstey KJ, Sachdev P, Butterworth P. Western diet is associated with a smaller hippocampus: a longitudinal investigation. BMC Med. 2015;13:215.
2. Gangwisch JE, Hale L, Garcia L, et al. High glycemic index as a risk factor for depression: analyses from the Women’s Health Initiative. Am J Clin Nutr. 2015;102:454-463.
3. Mastroiacovo D, Kwik-Uribe C, Grassi D, et al. Cocoa flavanol consumption improves cognitive function, blood pressure control, and metabolic profile in elderly subjects: the Cocoa, Cognition, and Aging (CoCoA) Study—a randomized controlled trial. Am J Clin Nutr. 2015;101:538-548.
4. Agarwal U, Mishra S, Xu J, Levin S, Gonzales J, Barnard ND. A multicenter randomized controlled trial of a nutrition intervention program in a multiethnic adult population in the corporate setting reduces depression and anxiety and improves quality of life: the GEICO study. Am J Health Promot. 2015;29:245-254.
5. Akkasheh G, Kashani-Poor Z, Tajabadi-Ebrahimi M, et al. Clinical and metabolic response to probiotic administration in patients with major depressive disorder: a randomized, double-blind, placebo-controlled trial. Nutrition. 2015 Sept 28. [Epub ahead of print]