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  • Taking Supplementation Seriously Part IV

    In past articles, we presented the case for insuring nutritional sufficiency of the essential vitamins and minerals through supplementation. There is little debate that these micronutrients are requisite for human survival, and that their supplementation may be an apt course for some. A healthy diet also provides several other nutritionally-beneficial elements which, like the vitamins and minerals, are not always present at optimal levels and thus can potentially benefit from supplementation.

    Here is a list of five dietary supplements that are worth considering as additions to the multivitamin. They are not meant to represent the "best" or "most useful" of the supplement field (which has little meaning given the individuality of metabolism); rather, these choices represent common dietary constituents that primarily function to broadly improve health and well-being (as opposed to addressing a single aspect of it). Each has a defined, critical role in normal human metabolism, and all but one are only obtainable through the diet.

    Omega-3 fatty acids and whey protein are sources of essential fatty and amino-acids, the two remaining classes of essential nutrients after the vitamins and minerals. Fiber supplements provide this oft-deficient dietary macronutrient, which along with probiotic bacteria are a major determinant in intestinal function and the maintenance of healthy gut microflora. Supplementing with the nutritionally non-essential Coenzyme Q10 can augment the levels of this general purpose fat-soluble antioxidant and critical component for cellular energy generation, which may be of particular significance for older consumers.

    Note that this list is a starting point; there are many additional dietary supplements that truly "supplement" the diet with nutrients that are often missing or suboptimal (phytonutrients such as carotenoids, isothiocyanates, and polyphenolic antioxidants are notable examples), as well as several well-studied natural ingredients that address specific health concerns but may not be "normal" constituents of the diet (herbal supplements such as milk thistle or saw palmetto fall into this category).

    Omega-3 fatty acids. Omega-3 fatty acids are long-chain polyunsaturated fatty acids from fish, shellfish, algae, or seed oils that have well-established roles in human nutrition, both as building blocks for the cell membranes of the brain, and as precursors to the human body's own natural anti-inflammatory system. Sufficient intake of omega-3s has been associated with reduced risk of heart disease, may facilitate healthy levels of circulating cholesterol and triglycerides, and may help maintain a healthy heartbeat and blood pressure. A balanced inflammatory response also relies on sufficient omega-3 fatty acids for the synthesis of endogenous anti-inflammatory factors.

    Alpha-linolenic acid (ALA), a constituent of seed oils from flax, perilla, and chia, is an essential nutrient for humans. The principle omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) from marine oils are not considered essential to human nutrition (we can make these from dietary ALA), but there is evidence some people may have trouble synthesizing sufficient levels of these fatty acids on their own, making them a good supplement choice. Omega-3 fatty acids from krill (a cold water crustacean) are in a potentially more bioavailable form (phospholipids) and contain high levels of the fat soluble antioxidant astaxanthin. Initial studies of krill oil suggest it may have a more potent lipid-lowering effect than other cold-water fish oils, meriting its choice as an omega-3 source.

    Whey Protein. It's not a capsule, and might be better described as a food product, but whey deserves consideration for increasing the amount of high-quality protein and essential amino acids in the diet. Whey protein is the "soluble" protein fraction from milk, and is commonly sold as a concentrate (most often about 70 percent protein with very low amounts of milk sugar or fat) or isolate (>90 percent protein, usually fatand lactose-free ), as well as in flavored pre-mixes or ready to drink beverages. Diets which are higher in protein have been associated with better glycemic control, normalized blood lipids, and have been shown to promote greater fat reduction, thermogenesis, and energy expenditure than high carbohydrate or high fat diets. Protein can also be more satiating than other macronutrients. "Fast proteins," like whey, are quickly digested and absorbed, which results in large, rapid increases of amino acids in the bloodstream following a meal, signaling fullness. Compared to other common protein supplements (soy, casein), whey exhibits superior appetite suppression when taken with a meal as 25 percent of total calories.

    Many of the health benefits of whey have been attributed to its high concentration of branched chain amino acids (BCAAs), a group of three nutritionally essential amino acids (leucine, isoleucine, valine). BCAAs serve as muscle fuel (which is why whey is often considered a “sports” supplement), but they may also stimulate the bodies basic satiety response. BCAAs also aid in fat loss, preserve lean body mass, and may help to lower insulin levels following a meal.

    Probiotics: Probiotics are living microorganisms, which upon ingestion in sufficient numbers, exert health benefits beyond general nutrition. Probiotic bacteria and yeast can reside on the surfaces of mucosal tissues (such as the gastrointestinal or upper respiratory tract) and provide a living barrier to environmental insults. Probiotic bacteria function in a variety of ways; they can inhibit the growth or block the attachment of rival pathogenic bacteria, they can improve the barrier function of mucosal membranes (providing protection from pathogens or toxins), they bolster immune function, produce vitamins, and enhance mineral absorption. Probiotic bacteria can play significant roles in systemic detoxification by trapping and metabolizing harmful dietary compounds or heavy metals. The production of the short chain fatty acids by probiotic bacteria in the intestines (from the fermentation of dietary fiber) improves the detox function of the liver and skin; this may also contribute to some of the anti-carcinogenic properties of dietary fiber.

    Probiotic supplements come in a myriad of forms and formulations, encompassing a wide variety of bacterial species and potency (probiotic potency is expressed in colony forming units—CFU—which is a measurement of the number of bacteria per serving.) A good starting point for general health maintenance would be a multi-strain product (having more than one type of bacteria) at a moderate potency (3–10 billion organisms); this is similar to the probiotic intake from a diet that contains fermented foods.

    Fiber Supplements: Fibers are polysaccharides (complex carbohydrates) that are indigestible by humans, yet have some significant roles in general health maintenance. The bulk of fiber and its resistance to digestion lend it satiating properties in the stomach; these same properties also cause it to increase the bulk of stool and hasten the transit of digested food through the intestines. This increase in gastric motility helps to minimize exposure of colonic epithelial cells to potential carcinogenic compounds or other dietary toxins. Dietary fibers can bind up bile acids and cholesterol, and prevent them from being re-absorbed; this facilitates the body’s ability to rid itself of excess cholesterol. Some fibers can also be specifically digested (fermented) by beneficial colonic bacteria into short chain fatty acids (like lactate or butyrate), which have their own health benefits throughout the body. Fermentable or prebiotic fibers (such as inulin and fructooligosaccharides) are available as supplements as well and are an appropriate complement to probiotics.

    There is convincing evidence that fiber intake reduces the risk of colon and breast cancers and cardiovascular disease; it has also been associated with healthy body weight, serum cholesterol levels, blood sugar control, and blood pressure. Unfortunately, the overwhelming majority of adults in the United States do not get the daily recommended intake of fiber, which is 38 grams/day for men 19–50 (30 grams/day for men over 50) and 25 grams/day for women 19–50 (21 grams/ day for women over 50). Even a modest increase to 20 grams a day from average current dietary levels has been estimated to reduce the rate of colorectal cancer by 40 percent. The fiber in our diets is heterogenous, containing several types of gums, pectins, lignans, cellulose, beta-glucans, fructans, and digestion-resistant starches. A good choice in fiber supplements would contain a mixture of multiple fiber types.

    Coenzyme Q10. Despite being the only member of the list that isn’t a nutritionally essential nutrient or a major component of the diet (young, healthy people can make sufficient CoQ10 for their metabolic needs), the potential health benefits of CoQ10 merit its consideration as part of a supplement regimen, especially in older consumers. CoQ10 is a fat-soluble substance that is an essential component of the energy production system in cells. It is found in each cell in the body, but is particularly concentrated in tissues which have large energy requirements (like the heart). There are also substantial amounts of CoQ10 in the blood, protecting circulating lipids (LDL and HDL) from oxidative damage. Supplemental CoQ10 has been the subject of numerous studies, particularly in applications for improving cardiovascular health (as in subjects with chronic heart failure, exercise-induced angina, or hypertension); it may also be protective of the cardiovascular system in diabetics. CoQ10 continues to be the subject of academic research, and is beginning to find acceptance as a supplement amongst mainstream medical practitioners.

    The average diet contains only a small amount of CoQ10, which is generally poorly absorbed (by some estimates, as little as two to three percent of dietary CoQ10 is absorbed). Variability in absorption also appears to be age-dependent; case reports suggest decreased fractional absorption in older patients. Several "enhanced absorption" strategies and products have been developed to overcome this hurdle, with improved uptakes verified by clinical data. Recently, the second naturallyoccurring form of CoQ10 (ubiquinol) has been introduced into the supplement market (CoQ10 supplements have typically been in the form of ubiquinone.) Ubiquinol is absorbed more efficiently than ubiquinone, especially in individuals who have difficulty absorbing CoQ10.

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  • Not long ago, ScienceDaily published an article entitled, “A Ton of Bitter Melon Produces Sweet Results For Diabetes.” This headline is but one of many recent announcements regarding the benefits of an ancient vegetable that is a culinary treat throughout much of the world. Unfortunately, bitter melon and its many benefits remain unknown to most Americans.

    Bitter melon grows in the tropical and subtropical areas of the East Africa, Asia, India, South America and the Caribbean. It is used traditionally as both food and medicine in all of these areas. Momordica charantia goes by many names and is known as bitter melon, bitter gourd, balsam pear, karela, and pare. Most Westerners will identify bitter melon as looking like a pale green or green cucumber with warts. Indian varieties may be whitish to gray-green, as well. Commercial cultivars can range up to a foot or more in length, whereas wild bitter melon varieties may measure only an inch or so, more than making up for their small size with greater bitterness and intense flavor. The gourd becomes more bitter as it ripens. As a food, unripe bitter melon is used fresh in salads, cooked into soups and curries, employed as a flavoring for eggs, meat and so forth.

    Long popular as part of the cuisine of South Asia and China, bitter melon today is conquering new gastronomic territories. Okinawans, renowned for longevity, are extremely fond of a small local variety reputed to confer health benefits. From Okinawa and other sources, bitter melon is becoming increasingly widespread on the Japanese mainland. This reflects an East Asian trend typical of Korea as well as Japan: Highly flavored and colored nutrient-dense foods are being adopted as everyday sources of health. Hence black and red rice, black garlic, bitter melon and other such foods and condiments are being embraced.

    A Plethora of Benefits
    Almost every part of the Momordica charantia plant has been used in traditional medical practices, including not just the fruit, but also the leaves/vines, seeds and roots. Folk and traditional systems often suggest bitter melon for microbial infections, sluggish digestion and intestinal gas, menstrual stimulation, wound healing, inflammation, fever reduction, hypertension, and as a laxative and emetic. All these benefits are from a plant with fruit that has been proven safe by centuries of oral consumption. The only concern generally of note is that bitter melon seed consumption is not recommended for those seeking to become pregnant.

    In South Asia, bitter melon is recommended to support immune health. Some of the effects are direct and some are indirect. Benefits include the inhibition of the growth of a variety of gram-negative and gram-positive bacteria, including E. coli, Salmonella, Staphylococcus, Streptococcus and H. pylori. Extracts, similarly, according to in vitro studies, appear to have an impact on a number of viruses. For instance, bitter melon constituents may prevent viral penetration of the cell wall. Immune effects include support for healthy T-helper cell ratios, natural killer cell populations and related mechanisms.

    With current problems involving overweight and obesity, some of the more attractive actions of bitter melon involve controlling weight gain in the face of the consumption of excessive calories. Animal studies have demonstrated that bitter melon can reduce insulin resistance and visceral obesity caused by a high-fat diet. Similarly, bitter melon may be protective against many damaging results of high fructose diets, including diet-induced hyperglycemia, hyperleptinemia, hyperinsulinemia, and hypertriglyceridemia. The American Medical Association currently is recommending that added sugars should not account for more than five percent of the diet, yet added sugar, especially fructose and “corn” sugars, are found everywhere in the American food supply, although often hidden. Bitter melon may offer some nutritional protection against these added sugars.

    Traditional uses and preclinical research provide a very positive picture of bitter melon. Human trials have confirmed many of these findings. In clinical trials, the fresh fruit, its freshly squeezed juice and the homogenized suspension of bitter melon have led to significant reductions in both fasting and postprandial blood glucose. The caveat is that the successful trials in the literature as a rule have used almost exclusively fresh preparations. For whatever reasons, dry extracts have not fared well in clinical trials. Perhaps this is due to the fact that dry extracts usually are concentrated for charantins even though, according to some research, charantins, the saponins commonly selected for “standardized” preparations, may be inactive or only weakly active. Another possibility is that the most active compounds in bitter melon rapidly deteriorate in most dried powders and extracts.

    If you like the taste of bitter melon, the success of freshly prepared materials in clinical trials is great news because it means that the vegetable may deliver not just a taste treat, but also health benefits when consumed raw and cooked in salads, soups, curries, egg and meat dishes, etc. There also remains another option. Recent research suggests that a special form of bitter melon, especially with proper handling, may deliver on the promise of the fresh material even when dried and delivered in capsules and tablets.

    Sometimes Wild Is Better!
    With many grains, fruits and vegetables, wild genotypes retain healthful qualities that have been bred out of cultivated varieties. For instance, Khorasan wheat (Kamut), a much older form of wheat, provides more protein, minerals and more complex carbohydrates with lower gluten levels than is true of modern wheat. Similarly, carrots initially most often were purple rather than orange because of the vastly greater amounts of phytonutrients in the form of anthocyanidins. Lettuce was more bitter, and so forth and so on.

    With bitter melon, much the same is true. There are literally hundreds of different forms of bitter melon found in China and India. In many ways, the most interesting of these nutritionally are the “wild” forms found in India.

    Recently, a comparative trial in animals looked specifically at the differences among commercial herbal extracts of bitter melon of Chinese, Indian and Indian wild genotype origin. The goal was to establish benefits with regard to blood sugar and insulin regulation and also parameters linked to blood pressure. Very little work has been performed with wild genotypes of bitter melon, even though there are a great many of these in India alone. Most information available tends to cover topics such as the effect of the wild forms on inflammatory responses. Hints in the literature suggest that the blood sugar effects of some of these wild genotypes could be more potent than in the cultivars commonly used for extraction. For instance, it has been found that extracts of bitter gourd activate cellular machinery to regulate energy production (technically, Amp-activated protein kinase) and the way that fats are handled by the liver. These components can account for as much as 7.1 g/ kg of the dried wild material.

    In a just published trial that did look at wild bitter melon, over a period of 60 days the effect of an extract from the wild genotype of bitter melon offered commercially under the name Glycostat proved to be more efficacious than the varietals typically used in Chinese and Indian preparations and certainly more consistent in influencing all the health parameters tested. Wild bitter melon was compared with two commercially available Chinese and Indian preparations in an animal model with a standard test called a Glucose Tolerance Test (GTT). In this test, a fixed amount of glucose is consumed and then the amount that accumulates in the blood (Area Under the Curve/AUC) is measured and the change (delta) is calculated. A smaller change is good because it means that the body is rapidly taking the glucose into the tissues and that there is good insulin sensitivity. All the bitter melon extracts reduced the increase in blood sugar. However, wild bitter melon was superior to both the Chinese and Indian extracts and it was the only extract to deliver statistically significant results. Of particular note, this greater benefit was achieved without elevating insulin levels.

    Other interesting findings included the wild extract’s significant influence on the nitric oxide system (influencing whether the blood vessels can dilate), a system that controls blood fluid volume known as the renin-angiotensin system (RAS) and the closely related angiotensin converting enzyme (ACE) activity. These three systems and activities influence blood pressure and cardiovascular health and in each of them, wild bitter melon either was the only extract that exhibited significant activity or it was more active compared to the Chinese and Indian extracts.

    Concluding Thoughts
    Bitter melon is yet another example of a traditional food and health aid that has made good when tested against modern Western standards. The benefits are real in areas such as blood glucose and blood pressure support—with the caveat that until now bitter melon needed to be eaten in large amounts or the freshly prepared juice consumed regularly in order for the benefits to be realized. Extracts and dried powders have been less successful, perhaps because unstable or for other reasons. A specially prepared wild bitter melon extract produced with special processing appears to have solved this limitation. Wild bitter melon extract supports both blood sugar and blood pressure health, all without the bitter taste.

  • Contributing Author Eric Dohner, MD

    THE DOMINANT RISK FACTOR FOR DEMENTIA IS ADVANCING AGE, UNFORTUNATELY, NO ONE KNOWS HOW TO REVERSE AGING. HOWEVER, THE SECOND MOST IMPORTANT RISK FACTOR IS POOR CIRCULATION, AND THIS IS SOMETHING YOU CAN EASILY CORRECT.

    Advancing age is the dominant risk factor for dementia. Individuals under age 65 rarely develop dementia, but then risk doubles every five years after age 65. In individuals over age 85, up to one-half exhibit signs of the onset of dementia.

    There is little we can do about aging, but we can address other dementia risk factors which arise with aging. In particular, low blood flow to the brain has repeatedly been shown to be one of the most important risk factors for dementia, and it is an easily correctable factor.

    Brain Blood Flow and Blood Pressure

    Though the brain makes up only about two percent of the body, 15 to 20 percent of the blood circulation in young adults goes to the brain to provide the necessary oxygen to support the energy demands of the brain. However, as we age, blood flow to the brain steadily declines. In men, brain blood flow falls about 15 percent over 50 years. In women, the decrease in brain blood flow is far greater, up to 30 percent by age 75.

    Blood flow to the brain declines with age because blood pressure typically declines with age. Lower blood pressures correspond to lower brain blood flow, particularly when sitting or standing as the brain is at the top of the body, and blood pressure must overcome the force of gravity. While in middle-aged people a major health concern is high blood pressure (hypertension), in older individuals, low blood pressure (hypotension) is common and can become a serious health issue, particularly with respect to brain health.

    Blood pressure begins to decline around age 60, and by age 75, half of Americans have a resting diastolic blood pressure (the lower number in a blood pressure recording) below 70 mmHg. 70 mmHg is considered a critical threshold for dementia risk, as the risk of dementia more than doubles for an older individual with a resting diastolic pressure below 70 mmHg for several years or more. By age 85, two-thirds of people have a resting diastolic pressure below this level.

    Blood Pressure and Dementia—The Evidence

    The influence of low blood pressure on the development of Alzheimer's was first reported more than 20 years ago in a Swedish study of 1800 people which showed that below normal (less than 120/80 mmHg) blood pressures were associated with a 2-fold to 10-fold increased risk.1

    The Bronx aging study subsequently confirmed that below normal blood pressures were associated with an increased risk of Alzheimer's, and also indicated that for individuals with resting diastolic pressures below 70 mmHg, the risk increased by a factor of two or more.2 Additional confirmation has recently been provided in a very large study completed in Norway and involving almost 25,000 patients who were followed for up to 27 years.3

    Additional research also confirms that reduced brain blood flow arising from chronic low blood pressures is likely the primary underlying cause of dementia. Direct measurements of brain blood flow have shown that increased blood flow is associated with reduced risk of dementia.4 Also, a very recent mouse study completed in Israel demonstrated that one hour daily exposures in a hyperbaric chamber, which increased oxygen levels in the blood, significantly reduced the physiologic nd behavioral effects of Alzheimer's within a two week period of time.5

    Blood Pressure and Aging

    So why does resting blood pressure fall as we age? Whenever we are sitting or standing, gravity is pulling the blood in our veins, and other fluids in our body, down towards our legs. Because people have relatively soft skin (women more so than men), our skin expands allowing blood and fluid to pool into our legs and lower body.

    In young individuals, the soleus muscles in the calf of the legs prevent this pooling from becoming excessive. These specialized muscles serve as pumps which collect the fluid pooling into the legs and pumps it back to the heart. The soleus muscles play such an important role in ensuring blood return to the heart that they are often called our "secondary hearts."

    As we age, however, it is common for our soleus muscles to become unable to perform the task of continually pumping blood and lymphatic fluid back up to our heart. The soleus muscles are maintained through squatting activity, and while our ancestors squatted to rest, adults in the western world rarely squat. To rest, we sit in chairs, and sitting does not exercise the soleus muscles.

    Weak soleus muscles allow fluid to continually build up in the legs during the day. This pooling is often first recognized by the presence of swollen feet or ankles, or by the appearance of varicose veins. But, if the fluids in your body are not being returned back to the heart, the output from your heart falls. This drop in cardiac output leads to a drop in blood pressure, and as a result, a decrease in blood flow to the brain.

    Maintaining a Healthy Blood Pressure

    The good news is that low blood pressure can be easily corrected. While low blood pressure can be due to medication interactions, or other condition, if you have swollen feet and ankles, varicose veins, unexplained fatigue, or cold hands and feet, it is most likely that the cause of your low blood pressure is weak soleus muscles.

    Like any muscle, your soleus muscles can be retrained. The best way to do this, of course, is to replace your sitting time with squatting time or to take up Tai Chi or Yoga. But if active exercise does not fit your lifestyle, you have the option of utilizing a "passive exercise" approach to building up your soleus muscles.

    The soleus muscles can be activated through a reflex initiated with an appropriate mechanical stimulation to the bottom of the feet. To take advantage of this reflex response, "passive exercise" devices have recently been introduced onto the market which allows you to exercise your soleus muscles while you sit. Retraining your soleus muscles generally requires a couple of hours a day of "exercise", but over the period of several months, your soleus muscles will regain their pumping ability, your symptoms of fluid pooling will disappear, and your resting blood pressure will return to normal.

    Preventing Dementia

    Recent research has provided encouraging evidence that correcting low blood pressure in older individuals is capable of reversing the earliest stages of dementia in a relatively short period of time.6 In a study on 70– 90-year-old participants living in an assisted living center, those with chronically low resting blood pressure were found to require twice as much time to complete a cognitive test than their fellow residents who had normal blood pressures. Undertaking soleus exercise for just one hour per day, over a four-month period of time, served to correct the low blood pressures, and cognitive test times fell by half.

    While dementia is often considered an irreversible effect of aging, research has clearly shown that dementia arises, in large part, as a result of the reduced brain blood flow which occurs as we age. By maintaining normal blood pressure as we age, we should be able to slow, or even reverse, the development of dementia and perhaps even prevent future cases of Alzheimer's and other debilitating forms of dementia.

    References

    1. Guo Z, et al. (1996) Low blood pressure and dementia in elderly people: The Kungsholmen project. BMJ 312:805–8.
    2. Verghese J, et al (2003) Low blood pressure and the risk of dementia in very old individuals. Neurology 611:1667–72.
    3. Gabin, JM, et al (2017) Association between blood pressure and Alzheimer disease measured up to 27 years prior to diagnosis. Zlaheimer's Research and Therapy. DOI10.1186/s13195-017-0262
    4. Ruitenberg A, et al (2005) Cerebral hypoperfusion and clinical onset of dementia. Annals Neurology 57:789–94.
    5. Shapira R, et al (2018) Hyperbaric oxygen therapy ameliorates pathophysiology of 3xTg-AD mouse model by attenuating neuroinflammation. Neurobiology of Aging 62:105.
    6. McLeod K, et al (2017) Reversal of cognitive impairment in a hypotensive elderly population using a passive exercise intervention. Clinical Interventions in Aging 12:1859–66.
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