Omega-3 Fatty-Acid Intake Improves Neurodevelopment in Preterm Girls. Good Confirmation for those with Dementia??

If this is true for brain development in early life, then in my mind it is a good confirmation that the omega-3 fatty acids really are good for our brain at any age. But what about those little boys??

Omega-3 Fatty-Acid Intake Improves Neurodevelopment in Preterm Girls

By Allison Gandey

January 15, 2009 — Investigators observed an 80% reduction in the proportion of baby girls with significant mental delays when they had a diet rich in docosahexaenoic acid (DHA). These are the findings of a randomized controlled trial published in the January 14, 2009 issue of the Journal of the American Medical Association.

Although the researchers did not see statistically significant benefits in boys or babies born weighing less than 1250 g, they say that there appeared to be a reduction in the proportion of babies with significant mental delay in these groups with high-DHA treatment.

“We recommend increased DHA for all preterm infants born at less than 33 weeks’ gestation,” lead author Maria Makrides, PhD, from the Women’s and Children’s Hospital in Adelaide, Australia told Medscape Neurology & Neurosurgery.

We think that the level of DHA used in the treatment arm of our study should become the new gold standard for preterm infants.

“We think that the level of DHA used in the treatment arm of our study should become the new gold standard for preterm infants, whether it is supplied through breast milk or infant formula,” Dr. Makrides said.

“It is important to note that we did not find negative effects of increasing the dietary DHA content. The high-DHA babies grew as well as those fed standard DHA, and we have confidence that the level of DHA used in the study — around 1% of the total dietary fat — was safe,” she added.

Mental Development Index Higher Among Girls Receiving Fatty Acids

The research team randomly assigned babies born at less than 33 weeks’ gestation to either a high-DHA diet or a standard-DHA diet from about day 4 of life until the time they were due to be born. Infants were from 5 Australian tertiary hospitals.

“An important and unique aspect of the study was that the intervention was largely delivered to the baby through expressed breast milk,” Dr. Makrides said. “We supplemented nursing women with about 1 g of DHA per day in tuna-oil supplements to increase the DHA content of their milk.” If the mother could not express enough breast milk for her baby, an infant formula with a matching DHA content was provided.

Of the 657 infants enrolled, 93.5% completed the 18-month follow-up. Bayley Mental Development Index among girls fed the high-DHA diet was higher than for girls receiving standard DHA in unadjusted and adjusted analyses (unadjusted mean difference, 4.7; 95% CI 0.5 – 8.8; adjusted mean difference, 4.5; 95% CI, 0.5 – 8.5).

The Mental Development Index among boys did not differ between groups. For infants born weighing less than 1250 g, the index in the high-DHA group was higher than with standard DHA in the unadjusted comparison (mean difference, 4.7; 95% CI, 0.2 – 9.2). But this did not reach statistical significance following adjustment for gestational age, sex, maternal education, and birth order (mean difference, 3.8; 95% CI, -0.5 to 8.0).

No Improvements Found in Boys

“The lack of responsiveness of boys to the intervention is puzzling,” the researchers write, “and the reasons are unclear.”

“We can only speculate that there are differences in the metabolism of boys and girls that we do not yet understand,” Dr. Makrides said during an interview. “The higher metabolic rate in boys may mean that they utilize much of the DHA they receive into energy. Also, boys may have a higher requirement for DHA. Clearly, this is an area of important research for the future.”

Dr. Makrides pointed to a number of limitations to the study, including the fact that the majority of women in the high-DHA group correctly guessed their group allocation. “We tried to set up a double-blind study, but in the end about 70% of women correctly guessed they were in the DHA group. This was because they had fishy burps,” she said. “This could have introduced bias.”

The researchers plan to continue following this cohort. “Should these differences persist to school age, when we next plan to follow up these children,” Dr. Makrides noted, “the potential significance to the children, the families, and the health and education system will be large.”

This study was supported by a grant from the Australian National Health and Medical Research Council and by Channel 7 Children’s Research Foundation of South Australia. Treatment and placebo capsules were donated by Clover Corp, and infant formula was donated by Mead Johnson Nutritionals and Nutricia Australasia. Dr. Maria Makrides serves on scientific advisory boards for Nestlé, Fonterra, and Nutricia. Coauthor Dr. Robert Gibson, also from the Women’s and Children’s Hospital in Adelaide, serves on scientific advisory boards for Wyeth, Fonterra, and Nestlé. Coauthor Dr. Karen Simmer, from King Edward Memorial Hospital and University of Western Australia, in Perth, serves on a scientific advisory board for Wyeth.

JAMA. 2009;301:175-182. Abstract

Ginkgo biloba for Prevention of Dementia — Forget About It

Several preclinical studies have suggested that Ginkgo biloba extract is neuroprotective, although some treatment studies (including meta-analyses) have shown little cognitive benefit. Americans are estimated to spend $100 million yearly on gingko in the hope that it enhances memory or prevents memory loss. To ascertain whether G. biloba prevents all-cause dementia and Alzheimer disease, researchers conducted the Ginkgo Enhancement of Memory (GEM) study, a multisite, randomized, controlled 6-year trial.

Steven T. DeKosky, MD; Jeff D. Williamson, MD, MHS; Annette L. Fitzpatrick, PhD; Richard A. Kronmal, PhD; Diane G. Ives, MPH; Judith A. Saxton, MD; Oscar L. Lopez, MD; Gregory Burke, MD; Michelle C. Carlson, PhD; Linda P. Fried, MD, MPH; Lewis H. Kuller, MD, DrPH; John A. Robbins, MD, MHS; Russell P. Tracy, PhD; Nancy F. Woolard; Leslie Dunn, MPH; Beth E. Snitz, PhD; Richard L. Nahin, PhD, MPH; Curt D. Furberg, MD, PhD; for the Ginkgo Evaluation of Memory (GEM) Study Investigators 

Published in JAMA The Journal of the American Medical Association 2008;300(19):2253-2262.

In summary, in this randomized clinical trial in 3069 older adults with normal cognitive function or mild deficits, G biloba showed no benefit for reducing all-cause dementia or dementia of the Alzheimer type. A central issue in testing of complementary and alternative medications is the formulation of the compounds. This study used a requisite standardized formulation of G biloba extract with specified amounts of the active ingredients in a dosage based on the highest doses used and reported in the literature. The extract we tested is among the best characterized and is the one for which the most efficacy data are available. Thus, we believe that the results are applicable to other G biloba extracts. Based on the results of this trial, G biloba cannot be recommended for the purpose of preventing dementia.

I’ve personally had the pleasure of meeting Dr. Steven T. DeKosky, MD. Dr. DeKosky had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.  I am quite pleased and fortunate to have Dr. Oscar L. Lopez , MD as my personal neurologist at the University of Pittsburgh Medical Center (UPMC).

This well-planned and well-executed study definitively answers the question of whether G. biloba prevents dementia. Considering the lack of efficacy reported here, these measures are unlikely to yield positive findings.

In the present economy, can people put the $100 million to better use? I don’t know the answer to this. However, I would not criticise anyone for taking and/or considering taking Gingko biloba.

Ckick here for the Gingko Fact Sheet.

 

David

 

Winter Blues? Feeling Sad? Dementia and Seasonal Affective Disorder (SAD)

 

 

“This little light of mine…”

 

sad6

 

Do you or your loved ones suffer from:

 

 

 

∞  Feeling sad, grumpy, moody, or anxious

∞  Avoiding social situations and feeling a loss of interest

     in the activities you used to enjoy

∞  Eating more and craving carbohydrates, such as bread

     and pasta

∞  Weight gain

∞  Sleeping more and feeling drowsy during the daytime

∞  A drop in energy level and fatigue

∞  A tendency to oversleep

∞  Difficulty concentrating

∞  Increased sensitivity to social rejection

∞  Feeling that your physical problems worse (even if they aren’t)

 

Then you may be suffering from the winter blues or seasonal affective disorder (SAD). It is a type of depression that affects a person during the same season each year. If you get depressed in the winter but feel much better in spring and summer, you may have SAD. Anyone can get SAD, but it is more common in:

  1. People who live in areas where winter days are very short or there are big changes in the amount of daylight in different seasons.
  2. Women.
  3. People between the ages of 15 and 55. The risk of getting SAD for the first time goes down as you age.
  4. People who have a close relative with SAD.

It is possible for an individual to experience many or all of the above symptoms but yet do not feel depressed. I used to see this more frequently with patients who have more difficulty being in touch with their feelings.

For someone suffering from aging or dementia along with SAD, whether mild or severe, their behaviors and moods may be markedly worsened and more difficult to understand. He/she may feel more confused earlier in the day (sundowners) than usual. Their aches and pains might be worse or they might become more withdrawn. Their dementia may not be getting worse. This is because we turn the clocks back one hour and the days are ‘shorter’ which result in less sunlight.

As many as half a million people in the United States may have winter-onset depression. Another 10% to 20% may experience mild SAD. SAD is more common in women than in men. Although some children and teenagers get SAD, it usually doesn’t start in people younger than 20 years of age. For adults, the risk of SAD decreases as they get older. Winter-onset SAD is more common in northern regions, where the winter season is typically longer and more harsh.

When I practiced psychiatry in Pennsylvania, the phone calls always increased during October and particularly after Daylight Saving Time ended. Ironically, I saw very little SAD in patients where I lived in California where it could even be sunny in the winter.

SAD has been linked to a biochemical imbalance in the brain prompted by shorter daylight hours and a lack of sunlight in winter. Just as sunlight affects the seasonal activities of animals, SAD may be an effect of this seasonal light variation in humans. As seasons change, people experience a shift in their biological internal clock or circadian rhythm that can cause them to be out of step with their daily schedule. For those who care, research locates the clock in the suprachiasmatic nucleii of the hypothalamus. It’s common to all mammals and that is rather interesting since the hypothalamus is our primitive brain. That primitive part of our brain is very concerned with basic survival and knowing instinctively when darkness is coming, how long the days are, or when it may be time to seek shelter from predators; just the kinds of things that concerned primitive man.

Symptoms come and go at about the same time each year. For most people with SAD, symptoms start in September or October and end in April or May.

Symptoms of SAD keep coming back year after year. They also tend to come and go at about the same time every year. The changes in mood are not necessarily related to obvious things that would make a certain season stressful (like regularly being unemployed during the winter).

 

sadlady

A modest improvement in symptoms of dementia has been associated with the use of bright light in daytime, in an effort to improve their circadian rhythms, according to a study released on June 10, 2008 in the Journal of the American Medical Association (JAMA). Additionally, the use of melatonin resulted in improved sleep.

 

Not to worry! Tomorrow, I will discuss some of the treatments for SAD. I am still impressed with some of the results my patients and I would see when they received the appropriate treatment! They ended up feeling as happy as this smiling lady in the picture.

 

 

 

And a new vocabulary word today.   adumbrate  [a-duhm-breyt, ad-uhm-breyt]

  1. to produce a faint image or resemblance of; to outline or sketch
  2. to foreshadow; prefigure
  3. to darken or conceal partially; overshadow

 

Do you know the 80/20 rule?

— This is one of the best ways to make better use of your time. The 80/20 rule – also known as The Pareto Principle – basically says that 80 percent of the value you will receive will come from 20 percent of your activities.

 

— So a lot of what you do is probably not as useful or even necessary to do as you may think.

 

— You can just drop – or vastly decrease the time you spend on – a whole bunch of things.

 

— And if you do that you will have more time and energy to spend on those things that really brings your value, happiness, fulfilment and so on.

 

I utilize the 80/20 rule when it comes to managing my desk. 80% of the time I only use 20% of ‘stuff’ on my desk. The other 80% of my ‘stuff’ gets used only 20% of the time.

 

 

David

 

 

 

 

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