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Study finds risks for beta blockers with surgery

May 14th, 2008

From Reuters

People given a blood pressure drug known as a beta blocker to reduce heart risks before surgery were one-third more likely to die within a month and had double the risk of stroke compared with those given a dummy pill, Canadian researchers said on Monday.

The study is the largest, most rigorous to date looking at whether beta blockers do more harm than good in reducing surgery-related risks. Other, smaller studies have had mixed results.

“There is a real potential that beta blockers are causing serious harm in the surgical setting,” said Dr. P.J. Devereaux of McMaster University in Ontario, whose study appears in the journal Lancet.

“If my mother was undergoing surgery and given a beta blocker, I would be extremely upset based on this evidence.”

The findings challenge the long-held belief that giving people a beta blocker before major surgery protects them from heart risks brought on by the stress of the procedure.

Surgery often raises levels of a stress hormone known as catecholamine, which drives up a person’s blood pressure and heart rate. “Beta blockers block the effects of increased catecholamines, so the physiological rationale would say they would be beneficial to people,” Devereaux said in a telephone interview.

He and colleagues set out to test this idea. They studied more than 8,000 patients in 23 countries at 190 hospitals who were undergoing major surgery unrelated to the heart. People in the study had or were at risk for clogged arteries.

STROKE VS HEART ATTACK

Half were given the beta blocker metoprolol, sold by AstraZeneca as Toprol XL, two to four hours before and 30 days after their surgery. The other half got a placebo.

The doctors were looking for heart complications such as heart-related death, non-fatal heart attacks or a heart-stopping event known as cardiac arrest in which the person survived.

While the study did find people given the drug had fewer heart attacks and abnormal heart rhythms, they also were more likely to die or have a stroke.

The researchers said for every 1,000 people with similar risks undergoing non-cardiac surgery, the drug could prevent 15 people from having a heart attack, three from needing a shock to restore a normal heart beat, and seven from developing a type of heart rhythm known as atrial fibrillation.

But eight more people would die, five would have a stroke, 53 percent would have abnormally low blood pressure and 42 percent would have an abnormally slow heart beat.

“This is an important study because, although the beta blocker reduced the number of heart attacks that occurred following surgery, it caused more strokes, thus on balance causing more harm than good,” Peter Weissberg, medical director of the British Heart Foundation, said in a statement.

“This is why it is so important to undertake large clinical trials rather than assuming drugs will only do what is expected of them.”

Devereaux, who first presented his findings at the American Heart Association meeting in November, said he expects the study to stir debate about whether it is still wise to give patients a beta blocker before a major surgery.

“It is telling us something we didn’t realize in the past,” he said.

Link between statins and dementia complex

December 5th, 2007

From News – Revolution Health

Previous studies of a link between statins, a cholesterol lowering medication, and cognitive decline have produced mixed results. New research suggests that the relationship between statin use and cognitive decline appears even more complex than originally thought.

The study involved 1,146 African Americans aged 70 and older living in Indianapolis whose cognitive status was assessed in 2001 and again in 2004.

The Indianapolis-based researchers found that cognitive decline in people who took statins was less than in those who did not take statins.

However, those who continued to take statins from 2001 to 2004 had greater cognitive decline than those who were taking statins in 2001 but were no longer taking them in 2004. If statin use were directly associated with a reduction in cognitive decline, continuously taking statins would presumably produce the greatest effect.

“The relationship between statin use and cognitive decline is complex and subjected to unknown confounders,” Dr. Stanley Szwast, of Indiana University School of Medicine, and colleagues note in a report in the journal Neurology. “This effect may not be associated with the cholesterol lowering or anti-inflammatory action of statins.”

“We know that taking statin medication can protect against cardiovascular events such as heart attacks by lowering blood cholesterol. The question at hand is what effects do these medications have on brain function. Our study along with others shows promising results but larger controlled studies are needed,” Szwast noted in a statement.

SOURCE: Neurology, November 6, 2007

The Mediterranean Food Pyramid: What’s on the Menu?

November 28th, 2007

From RevolutionHealth

If you’re looking for a once-in-a-lifetime meal, you’re likely to find it at El Bulli, a restaurant on the Spanish coast in Catalonia that’s been called the best in the world by Restaurant Magazine. Though the dishes are wildly inventive, the ingredients are definitely salt of the earth: fresh fish, olive oil, garden-warm fruits and vegetables. In other words, foods commonly eaten in sun-drenched Mediterranean countries.

In recent years, these same foods have been hailed as a way to prevent illness and promote overall good health, leading many experts to conclude that the Mediterranean diet can benefit people across the globe.

Gifts from the Greeks

Mediterranean food first attracted scientific attention 50 years ago, when researchers noticed that people throughout Crete and southern Italy often lived well into their 80s and 90s without any sign of heart disease, cancer or other chronic ailments.

Since then, hundreds of studies have confirmed that a traditional Mediterranean menu

lots of dense, whole grain peasant bread and pasta, seasonal vegetables and some cheese and fruit, all spiked with olive oil and washed down with red wine

can indeed substantially lower your risk of heart attack and stroke.

This way of eating may also help prevent Alzheimer’s disease and diabetes and cut your chances of developing emphysema, asthma and hay fever. In addition, recent research suggests that it may ward off some cancers.

What seems to make the Mediterranean menu so healthful isn’t any one food, but the whole eating-low-on-the-food-chain package, says Jennifer Nelson, a registered dietitian and director of clinical dietetics at the Mayo Clinic in Rochester, Minn. “All ethnic eating is plant-based and unprocessed. It’s a wonderful, fresh way of looking at things that goes beyond the usual fast-paced, put-it-in-boiling-water, nuke-it way of eating.”

The specifics

A food pyramid is designed so the foods that make up most of your diet are at the base, and those that should be eaten in smaller quantities and less often are at the top. In the Mediterranean scheme, an abundance of whole grains, fruits, vegetables, beans and nuts, olive oil and dairy foods are daily fare. Fish, chicken, eggs and sweets are recommended just a few times a week, and red meat is limited to no more than 12 to 16 ounces per month.

Here’s a closer look at how this all stacks up:

Whole grains and potatoes. Wonder Bread may have been a staple of 1950s America, but unrefined grains have always been the starch of choice in most of the rest of the world. Whole grains including breads, pasta, rice, couscous and polenta, have more complex taste and texture, and have been shown to cut your risk of heart disease and diabetes. While starchy, white potatoes have come under fire lately for their high carb content, in the Mediterranean they’re often eaten in small portions or used sparingly in a larger dish.

Fruits, vegetables, beans, nuts, seeds. There’s simply no downside to fruits and vegetables

they’re low in calories and fat and high in the fiber and nutrients that stop high blood pressure, heart disease, some types of cancer and age-related eye disease. Can’t get past the boiled broccoli of your youth? The Mediterranean plan features options like grilled artichoke hearts and sun-dried tomatoes. Dry beans such as garbanzos (aka chickpeas

think hummus) and small amounts of nuts add quality protein.

Extra virgin olive oil. Experts used to think that a low-fat diet equaled a healthy heart. But it’s now clear that the kind of fat you eat is important, too. That’s where extra virgin olive oil comes in. Walter Willet, M.D., a professor of epidemiology and nutrition and the chair of the Department of Nutrition at the Harvard School of Public Health, says that unlike saturated or trans fats, olive oil lowers bad cholesterol and encourages good cholesterol, making it a fat that actually helps your heart. Still, olive oil is loaded with calories. Six teaspoons a day will give you all the benefits without expanding your waistline.

Cheese and yogurt. Cultured dairy foods like Greek yogurt and feta cheese are a big part of most Mediterranean cultures and may help intestinal health as well as provide calcium and protein. They’re often eaten every day but in modest amounts.

Fresh fish, poultry, eggs. It takes just 6 ounces of fish a week to knock points off your blood pressure and improve brain function in growing children. Seafood is even more important when it comes to your heart

cutting your risk of heart disease by as much as a third and halving your chances of sudden cardiac death. Chicken and eggs (no more than four a week, including those used in baking) play a supporting role.

Sweets. Desserts like gelato, baklava and French pastries should be eaten sparingly. Fruit is the most common dessert in the Mediterranean.

Red meat. Most of the arches in the Mediterranean date back thousands of years and definitely aren’t golden! Because it’s high in saturated fat and has been linked to some kinds of cancer, limit red meat (such as hamburgers) to a few times a month or avoid it completely.

Red wine (optional). A glass of vino a day, sipped slowly with your meal, can help ward off heart attacks. Because the benefit is in the fruit, not the alcohol, grape juice packs the same punch.

To help you spot Mediterranean-style foods, Oldways, a Boston-based nonprofit organization that promotes healthful eating, has designed a logo featuring an amphora

a traditional Mediterranean jug or vase

that will appear on some supermarket products. Look for it starting in late summer 2007.

Global Warming May Trigger Rise in Heart Deaths

November 24th, 2007

Hotter temperatures mean more ozone, and more strain on hearts, researchers say

From HealthScout

Soaring temperatures and high ozone levels work together to boost death risks from heart disease and stroke, researchers report.

They believe that global warming — which brings more heat and more ozone — may further increase the number of people who die of cardiovascular events.

“Temperature and ozone are strong factors in cardiovascular mortality during June to September in the Unites States,” noted the study’s lead author, Cizao Ren, from the Department of Epidemiology in the School of Medicine at the University of California, Irvine. “Temperature and air pollution combine to affect the health of large populations,” he added.

Ren expects the problem will get worse as the earth becomes hotter. “Increases in temperature and air pollution will have a strong affect on health,” he said.

His team based its findings on data on almost 100 million people living in 95 different areas across the United States from June to September.

These Americans were included in the National Mortality and Air Pollution Study, which tracked links between health and air pollution for the years 1987 to 2000.

Four million deaths from heart attacks or strokes occurred during the study period. Ren’s team compared death rates against changes in temperature during one day.

Ozone was a common link, they found.

In fact, the higher the ozone level, the greater the risk of cardiovascular death attributable to high temperatures, Ren’s team concluded.

Ozone levels ranged from an average of 36.74 parts per billion to 142.85 parts per billion, while daily temperatures ranged from 68 to around 107 degrees Fahrenheit.

When the ozone level was at its lowest, a 10-degree increase in temperature was associated with about a 1 percent increase in deaths from heart disease and stroke. However, when the ozone level was at its highest, there was a more than an 8 percent increase in deaths from heart disease and stroke, Ren’s group found.

The findings are published Nov. 21 in the online edition of the journal Occupational and Environmental Medicine.

Ozone is a pollutant strongly linked to weather conditions, particularly the amount of ultraviolet light in the atmosphere. Ozone is generated by a reaction between airborne nitrogen oxides, volatile organic compounds, and oxygen in sunlight.

Exposure to high levels of ozone can affect the airways and the autonomic nervous system, making people more susceptible to the effects of temperature changes, Ren’s team explained.

One expert agreed with the team’s conclusions.

“This paper reinforces what we know — that both temperature and ozone affect health, even to the extent that they affect mortality,” said George Thurston, an associate professor of environmental medicine at New York University.

Global warming will increase both temperatures and pollution, Thurston added, because higher temperatures are conducive to the production of ozone. “This will be a growing problem,” he said.

For the general public, the study raises questions about pollution and climate change, Thurston said. “The health effects may be even worse than thought,” he said. “There are health benefits to reducing climate change.”

Cutting back on the use of fossil fuels will help, Thurston said. “Reducing fossil fuel combustion will reduce climate change and pollution,” he said. “We have seen the problem, and it’s fossil fuel combustion. Now, all we have to do is come up with an alternative,” he said.

Herbal Sex Pills Pose Hidden Dangers

November 14th, 2007

From Washingtonpost.com

Many of the pills marketed as safe herbal alternatives to Viagra and other prescription sex medications pose a hidden danger: For men on common heart and blood-pressure drugs, popping one could lead to a stroke, or even death.

“All-natural” products with names like Stamina-RX and Vigor-25 promise an apothecary’s delight of rare Asian ingredients, but many work because they contain unregulated versions of the very pharmaceuticals they are supposed to replace.

That dirty secret represents a special danger for the millions of men who take nitrates _ drugs prescribed to lower blood pressure and regulate heart disease. When mixed, nitrates and impotency pharmaceuticals can slow blood flow catastrophically, leading to a heart attack or stroke.An Associated Press investigation shows that spiked herbal impotency pills are emerging as a major public health concern that officials haven’t figured out how to track, much less tame.

Emergency rooms and poison control hot lines are starting to log more incidents of the long-ignored phenomenon. Sales of “natural sexual enhancers” are booming _ rising to nearly $400 million last year. And dangerous knockoffs abound.

At greatest risk are the estimated 5.5 million American men who take nitrates _ generally older and more likely to need help with erectile dysfunction.

The all-natural message can be appealing to such men, warned by their doctors and ubiquitous TV commercials not to take Viagra, Cialis or Levitra.

James Neal-Kababick, director of Oregon-based Flora Research Laboratories, said about 90 percent of the hundreds of samples he has analyzed contained forms of patented pharmaceuticals _ some with doses more than twice that of prescription erectile dysfunction medicine. Other testers report similar results, particularly among pills that promise immediate results.

While no deaths have been reported, the AP found records of emergency room visits attributed to all-natural sex pills in Georgia, Chicago, Philadelphia, San Diego and elsewhere.

An elderly man in a retirement community north of Los Angeles took an in-the-mail sample and landed in the hospital for four days. A Michigan man sued the maker of Spontane-ES, blaming it for the stroke he suffered 20 minutes after taking a freebie that was advertised as “extremely safe.” Tim Fulmer, a lawyer representing Spontane-ES, said the pill did not contain any pharmaceutical and was not responsible for the stroke.

Mark B. Mycyk, a Chicago emergency room doctor who directs Northwestern University’s clinical toxicology research program, said he is seeing increasing numbers of patients who unwittingly took prescription-strength doses of the alternatives, a trend he attributes to ease of purchase on the Internet and the desperation of vulnerable men. He said he wouldn’t be surprised if there’d been undetected deaths from bad herbal pills.

Some herbal labels warn off users with heart or blood-pressure problems if they have taken their medicine within six hours; some doctors say 24 hours or more would be safer.